Abstract
Purpose
Our goals were to characterize associations of author number, author gender, and institutional affiliation on ratings and acceptances of abstracts submitted to one surgical education conference over 5 years.
Methods
We retrospectively reviewed all abstracts submitted between 2017 and 2021 to the annual meeting of the Association for Surgical Education (ASE). Abstract data included average rater scores, acceptance status, author lists, and institutional affiliations. We cross-referenced last author affiliation with top-40 National Institutes of Health (NIH)-funded institutions and used a gender determination software to code first and last author genders.
Results
We analyzed 1,162 abstracts. Higher reviewer scores demonstrated positive, weak associations with more authors [r(1160) = 0.191, p < 0.001] and institutions [r(1160) = 0.182, p < 0.001]. Significantly higher scores were noted for abstracts with last authors affiliated with top-40 NIH-funded institutions [4.18 (SD 0.96) vs. 3.72 (SD 1.12), p < 0.001]. Women were first authors (51.8%) (n = 602) and last authors (35.4%) (n = 411) of the time. Abstracts were rated significantly higher with women rather than men as first authors [3.98 (SD 0.99) vs. 3.82 (SD 1.12), p = 0.011] or last [4.01 (SD 1.04) vs. 3.82 (SD 1.10), p = 0.005]. Across all years, abstracts were accepted more often as podium or plenary presentations when submitted by women first [n = 279, 59.7% (p = 0.002)] or last [n = 183, 38.4% (p = 0.095)] authors.
Conclusion
Abstracts whose last authors were affiliated with top-40 NIH-funded institutions received significantly higher scores, possibly indicating increased tangible or intangible resources contributing to research efforts. Abstracts with women first and last authors scored higher and were more frequently invited for plenary and podium presentations.
Keywords: Surgical education, Surgical research, Authorship inflation, Gender
Introduction
As scientific publication rates continue to grow, efforts are being made to study the impact of various demographic and institutional information, such as author number, author gender, and institutional affiliation on acceptance to conferences and journals. For example, recent work has noted an increased number of authors on manuscripts submitted to peer-reviewed medical journals. Three major medical journals, Journal of the American Medical Association, the New England Journal of Medicine, and the British Medical Journal, observed a threefold increase in the average number of authors from 1990 to 2010 [1]. There is debate as to whether this trend reflects increasingly complex research collaborations and higher quality research or “authorship inflation,” whereby honorary authorship is gifted to more senior authors to hasten promotion, facilitate publication, and/or fulfill an obligation [1, 2].
Additionally, there have been questions surrounding sex and gender diversity in academic submissions and acceptances. One ongoing challenge involves the retention of women physicians in academia [3–9], particularly in the surgical specialties [10]. Encouragingly, between 2000 and 2017 the percentage of woman first authors of manuscripts published in surgical journals increased from 21.4% to 36.0%, and the percentage of woman last authors increased from 5.0% to 18.6%, rates which appear to be representative of woman residents and attendings over the same time period [11]. However, some surgical subspecialties, such as vascular surgery, maintained a disproportionately low number of women first and senior authors, even when compared to their low representation in the specialty [12]. Gender and sex inequity is also present at scientific meetings. A study of five major academic plastic surgery conferences in 2017 found that women were less often represented as invited speakers than their male counterparts, accounting for only 14.5% of speakers [13].
Authors’ academic affiliation also appears to affect acceptance and publication rates as studies have shown that academic reputation and rank is directly correlated with scholarly activity [2, 14, 15]. However, little research has elucidated whether work published within more resourced, more prestigious institutions is rated more highly by reviewers.
While many journals employ a double-blind peer-review process to help minimize influence of author name and affiliation on acceptance rates (e.g., Global Surgical Education—Journal of the Association for Surgical Education), others employ the single-blind process in which reviewers can see author names and institutional affiliations, while reviewer names are unknown to authors (e.g., JAMA Surgery, The American Journal of Surgery) or use an open (e.g., Journal of Cardiothoracic Surgery) or transparent (e.g., BMC Surgery) peer-review process. Given discussions regarding the benefits and drawbacks of blinded and unblinded peer review [16–18], analysis of research abstract ratings and acceptances may be helpful to better understand how potential biases relate to factors intrinsic or extrinsic to the review process. The goals of this study were to characterize and examine associations of author number, author gender, and institutional affiliation on ratings and acceptances of all abstracts submitted to one surgical education conference over a 5-year period that encompassed the COVID-19 pandemic.
Methods
We worked with the Association for Surgical Education (ASE) Surgical Education Research Committee (SERC) to obtain all abstracts submitted between 2017 and 2021 to the national annual meeting of the ASE. Abstract data included ASE topic area, individual rater scores (1 = poorest, 7 = best) and combined averages, acceptance status, complete author lists, and authors’ institutional affiliations.
Each abstract is reviewed by four-to-six reviewers who are blinded to author names and institutional affiliations. Reviewers are oriented to a uniform scoring rubric [19] which uses numerical scores paired with a verbal anchor/definition. Following scoring (and taking into account the authors’ stated presentation preference), all scores are compiled and averaged; the highest-scored abstracts are accepted. Of these, the top-scored abstracts are invited for presentation at the plenary session.
After reviewing all abstracts, we used Gender API (https://gender-api.com/), an “application programming interface (API)” software previously used in scientific and market research to estimate man or woman representation based on first name, to code first and last author genders [20]. The software classifies gender on a binary scale returning the terms “male,” “female,” or “unknown” based on an Internet search algorithm; however, we will use the terms “man” and “woman” in this manuscript to refer to gender as a social and behavioral construct distinct from chromosomal sex. For authors whose Gender API result was delivered with < 75% certainty, we manually determined author gender using an Internet search. We cross-referenced first and last author affiliation with top-40 National Institutes of Health (NIH) funded institutions (https://report.nih.gov/award/index.cfm). Abstract primary topics as provided by the ASE were quantified using descriptive statistics. We used one-way ANOVA to analyze continuous variables, Pearson chi-square to analyze categorical variables, z-score population proportions to compare submission to podium acceptance rates, and Pearson’s correlation coefficient (r) to assess associations between abstract score and number of authors/institutions. One-way ANOVA on ranks was used to analyze nonparametric, continuous variables. Our significance level was set at < 0.05. This study was approved by the Johns Hopkins Medicine (JHM) Institutional Review Board (IRB) (IRB00303967) prior to receiving abstract data from the ASE SERC and a waiver of consent granted.
Results
We analyzed 1162 abstracts; these included abstracts submitted for consideration as posters, oral/podium presentations, and workshops. The number of abstracts submitted increased steadily from 2017 (n = 166, 14.3%) to 2020 (n = 303, 26.1%) and decreased in 2021 (n = 212, 18.2%). The four most common abstract topics were (1) curriculum development (n = 259, 22.3%), (2) assessment (n = 208, 17.9%), (3) teaching methods (n = 176, 15.1%), and (4) simulation (n = 133, 11.4%). In 2021, the topic of curriculum development was the most common (24.5%) among all submitted abstracts and all other topic categories decreased (Table 1); notably, this was the first year the program committee added the topic of diversity, equity, and inclusion (DEI). The most commonly studied populations were residents/fellows (n = 528 studies, 45.4%) followed by medical students (n = 331 studies, 28.5%).
Table 1.
Number (%) of submitted abstract research topics by year
| Topic | 2017 | 2018 | 2019 | 2020 | 2021 | Total # |
|---|---|---|---|---|---|---|
| Curriculum development | 26 (15.7%) | 56 (24.7%) | 62 (24.4%) | 63 (20.8%) | 52 (24.5%) | 259 |
| Assessment | 34 (20.5%) | 58 (25.6%) | 41 (16.1%) | 51 (16.8%) | 24 (11.3%) | 208 |
| Teaching methods | 27 (16.3%) | 38 (16.7%) | 29 (11.4%) | 52 (17.2%) | 30 (14.2%) | 176 |
| Simulation | 28 (16.9%) | 24 (10.6%) | 30 (11.8%) | 33 (10.9%) | 18 (8.5%) | 133 |
| Program evaluation | 10 (6.0%) | 16 (7.0%) | 17 (6.7%) | 24 (7.9%) | 18 (8.5%) | 85 |
| Faculty development | 10 (6.0%) | 12 (5.3%) | 17 (6.7%) | 17 (5.6%) | 8 (3.8%) | 64 |
| Diversity, equity, and inclusion* | N/A | N/A | N/A | N/A | 18 (8.5%) | 18 |
| Other** | 31 (18.7%) | 23 (10.1%) | 58 (22.8%) | 63 (20.8%) | 44 (20.8%) | 219 |
| Total # | 166 | 227 | 254 | 303 | 212 | 1,164 |
**Examples of “Other” topics: data collection, patient communication, education resources, personality attributes, resident wellness, medical students’ away rotations, research productivity, third-year surgery clerkship, and use of social media
We found no difference in average number of authors [4.9 (95% CI 4.5–5.0) in 2017 to 5.3 (95% CI 5.0–5.5) in 2021, p = 0.059] and number of institutions [1.7 (95% CI 1.0–1.5) in 2017 to 1.8 (95% CI 1.5–1.5) in 2021, p = 0.401] (Table 2) per submission over the 5 years of this study. For all abstracts, the mean reviewer score was 3.88 (SD ± 1.09). Higher reviewer scores demonstrated positive, though weak correlations with more authors [r(1160) = 0.191, p < 0.001] and institutions [r(1160) = 0.182, p < 0.001]. Significantly higher scores were noted for abstracts with last authors who were affiliated with top-40 NIH-funded institutions [4.18 (0.96) vs. 3.72 (1.12), p < 0.001] (Table 3).
Table 2.
Mean number of authors and institutions per submission with 95% confidence interval by year
| Meeting Year | p value | |||||
|---|---|---|---|---|---|---|
| 2017 | 2018 | 2019 | 2020 | 2021 | ||
| Authors | 4.9 (4.5–5.0) | 4.8 (4.5–5.0) | 5.0 (4.5–5.0) | 5.3 (5.0–5.5) | 5.3 (5.0–5.5) | 0.059 |
| Institutions | 1.7 (1.0–1.5) | 1.8 (1.5–1.5) | 1.8 (1.5–1.5) | 1.8 (1.5–1.5) | 1.8 (1.5–1.5) | 0.401 |
Mean (95% confidence interval)
Table 3.
Average scores of submitted and accepted abstracts by author position, gender, and NIH funding
| Author position | Average score of all submitted abstracts (SD) | p value | |
|---|---|---|---|
| NIH Top 40 institution | Not NIH top 40 institution | ||
| Last author | 4.18 (0.96) (n = 405) | 3.72 (1.12) (n = 757) | p < 0.001 |
| Author position | Average score of accepted abstracts (total number) | ||
| NIH Top 40 institution | Not NIH top 40 institution | ||
| First author man (n = 366) | 4.30 (n = 133) | 4.08 (n = 233) | |
| First author woman (n = 461) | 4.56 (n = 184) | 4.30 (n = 277) | |
| Last author man (n = 543) | 4.43 (n = 190) | 4.15 (n = 353) | |
| Last author woman (n = 309) | 4.5 (n = 134) | 4.28 (n = 175) | |
NIH National Institutes of Health
Women were first authors (51.8%) (n = 602) and last authors (35.4%) (n = 411) of the time. Abstracts were rated higher with women rather than men as first (3.98 [0.99] vs. 3.82 [1.12], p = 0.011) or last [4.01 (1.04) vs. 3.82 (1.10), p = 0.005] authors (Table 4). Across all years, abstracts were accepted more often as podium or plenary presentations when submitted by women as first authors [n = 279, 59.7% (p = 0.002)] compared to men.
Table 4.
Number (%) of women first and last authors by year with corresponding podium/plenary presentation acceptance rates
| Abstract statuses | ASE meeting year | Women vs. men p value | ||||
|---|---|---|---|---|---|---|
| 2017 | 2018 | 2019 | 2020 | 2021 | ||
| Total submissions | 166 | 227 | 254 | 303 | 212 | – |
| Accepted posters | 80 (48.2%) | 95 (41.9%) | 101 (39.8%) | 101 (33.3%) | 101 (47.6%) | – |
| Accepted podiums | 43 (25.9%) | 50 (22.0%) | 50 (19.7%) | 69 (22.8%) | 100 (47.2%) | – |
| First author | ||||||
| Women submissions | 88 (53.0%) | 109 (48.0%) | 115 (45.3%) | 155 (54.8%) | 124 (58.5%) | p = 0.015 |
| Women podium acceptances | 44 (57.1%) | 53 (57.0%) | 50 (50.5%) | 62 (62.5%) | 70 (70.7%) | p = 0.002 |
| Submitted/accepted p value | p = 0.549 | p = 0.144 | p = 0.379 | p = 0.001 | p = 0.038 | – |
| Last author | ||||||
| Women submissions | 53 (31.9%) | 73 (32.2%) | 92 (36.2%) | 108 (35.6%) | 85 (40.1%) | p = 0.055 |
| Women podium acceptances | 26 (32.5%) | 35 (36.8%) | 39 (38.6%) | 38 (38.0%) | 45 (44.6%) | p = 0.095 |
| Submitted/accepted p value | p = 0.928 | p = 0.418 | p = 0.674 | p = 0.667 | p = 0.453 | – |
Includes population proportion p values comparing first and last author submission-vs.-podium acceptance rates and Chi-square comparing women-vs.-men submission and acceptance rates
ASE association for surgical education
Discussion
In this retrospective study reviewing 5 years of abstracts submitted to one surgical education conference, we found that abstracts whose first and last authors were women received higher scores and had higher podium/plenary presentation acceptance rates. Additionally, abstracts whose last authors were affiliated with a top-40 NIH-funded institution received higher scores. No evidence of authorship inflation was seen over time. These findings were consistent across all five study years despite the COVID-19 pandemic which has been widely shown to have negatively impacted research productivity in science, technology, engineering, and mathematics (STEM) fields [21–24].
Despite women comprising over half the US population and over half of US medical students since 2018 [25], women continue to be underrepresented in most surgical fields and as authors of scientific publications [20, 26, 27]. To better understand the ASE membership, we acquired gender data from ASE leadership. As of September 2022 and of the 32% of members who responded, 58% were women, 40% men, 1% non-binary, and 1% did not disclose; data were not available for prior years. Importantly, total membership includes physician (53% women), non-physician (76% women), trainee (59% women), and emeritus (no reported gender data) members. If we assume that these gender rates apply to those who presented abstracts for the two most recent years (2020 and 2021), we see that women first author podium presentations exceed the women membership rates. However, women last author podium presentations fell below these level (38% in 2020 and 44.6% in 2021). Additionally, authors need not be ASE members to submit/present abstracts at the annual meeting, so while it is interesting to compare these data, an additional work is needed to further understand how membership and authorship may interrelate.
In looking at the combined data across all 5 years of the study, we found that women first authors submitted just over half and women last authors contributed to over one-third of ASE meeting abstracts, likely reflecting the baseline demographics of students and resident physicians (commonly first authors) and practicing surgeons/non-clinician educators (commonly last authors). This appears to indicate equitable engagement by women in surgical education research; following blinded review, higher abstract scores, and acceptance rates associated with women first and last authors caused their work to be overrepresented (compared to their men peers) at plenary and podium sessions. This is similar to a finding by Arora et al. (2020) who found that, while the overall proportion of women speakers at medical conferences was lower than men, specialties with fewer women physicians overrepresented women speakers (compared to workforce baseline demographics) at conferences [28]. Although we found a balanced women-to-men first authorship ratio of 602:507, the women-to-men last-authorship ratio was 410:743. This is not surprising given that the number of practicing women surgeons and women in higher academic positions continues to be lower than men. However, the last-authorship rate increased over the course of the study period; should this trend continue we anticipate a comparable last author abstract submission ratio to coincide with the 2026 ASE meeting abstract submission deadline.
Another indicator of higher scored abstracts was last author affiliation with a top-40 NIH-funded institution. This association occurred despite the ASE’s blinded review process and is consistent with a study by Ross et al. (2006) who showed that, although blinding attenuates the association between institutional prestige and likelihood of abstract acceptance, well-resourced institutions still demonstrate higher abstract acceptance rates [29]. The causes for this are likely multifactorial and may include tangible and intangible benefits: tangible benefits include protected time and funding to perform research [30]; intangible benefits include larger collaborator networks, research-oriented infrastructure, and institutional cultures conducive to research collaboration [31]. This finding is important, because although women surgeons and non-clinician researchers/educators are underrepresented among NIH-funded principal investigators [32, 33], institutional factors may indirectly contribute to their productivity in surgical education research.
Finally, although our study data showed a slight increase in author numbers over time, this difference was not statistically significant. Authorship inflation is a prominent concern in academia; points that have been identified in prior research include increasing research complexity, increasing collaborations, or inclusion of minor contributory authors [34]. As research complexity increases, more resources and multi-institutional collaboration may be needed to successfully complete projects [34]. When assessing the association between number of authors and reviewer scores, we found a weak though significant association between higher numbers of authors and higher reviewer scores suggesting that, as other studies have found, increasing author counts reflect higher research complexity and higher quality work [1, 35]. Certainly, the number of authors of peer-reviewed publications has increased dramatically over time [1], demonstrated by the reduction of single-author publications in the New England Journal of Medicine between 1928 (78.4%) and 1968 (3.1%) [36]. More recently, one study found that the average number of authors per article published in four leading medical journals increased 53% between 1980 and 2000, from 4.5 to 6.9 [37]. The difference between our study’s findings and the published literature may reflect the shorter time course studied or the difference between conference abstract authorship and peer-reviewed, published manuscript authorship; longer term studies are needed to further elucidate this point.
Similarly, we found no increase in the number of institutions per submission over time; however, there was a significant and weakly positive association between higher number of institutions in a submission and higher reviewer scores. Given the blinded nature of abstract review, this may suggest that collaborative, multi-institutional efforts produce work of increased quality, complexity, and/or academic interest.
This study has multiple limitations, the first of which is the retrospective nature of the analysis. Another limitation was the use of Gender API, a gender determination application, to categorize the genders of the first and senior author. If gender was not provided by Gender API, or if output result was delivered with < 75% certainty, gender was manually determined using an Internet search. Both of these gender identification methods required assumptions of gender based on external presentation and did not permit non-binary options, and thus do not follow existing best practices for reporting sex and gender [38, 39]. However, at the time of this research, high-quality gender data were not available, and we believe this estimates differences in gender representation as accurately as possible at this time.
Conclusion
Our 5-year study of all abstracts submitted to the Annual ASE Meeting showed that abstracts with women first and last authors were scored higher and more frequently invited for plenary and podium presentations than those with men first or last authors. While women comprised the majority of first authors and their last-authorship rate increased over the course of the study, women last authorship has not yet reached parity. Additionally, abstracts whose last author had a top-40 NIH-funded institutional affiliation received significantly higher scores. Finally, our data demonstrated no difference in number of authors over time. Examining reasons women successfully author research presented at the ASE annual meeting is warranted to identify potential avenues for their retention in STEM fields. Additionally, we recommend prospective collection of self-reported labels, such as gender, that address broader identity continuums at time of abstract submission to better inform future studies of diversity in research.
Acknowledgements
This document was reviewed and approved by the Surgical Education Research Committee (SERC) and the Board of Directors of the Association for Surgical Education (ASE).
Funding
The authors did not receive support from any organization for the submitted work.
Data availability
The datasets generated during and/or analyzed during the current study are not publicly available as they contain identifiable information, but are available from the corresponding author on reasonable request.
Declarations
Conflict of interest
Ms. Cooney is an equity holder and Scientific Advisory Board Member in the start-up company, EduMD, LLC, for which Ms. Cooney is also the Vice President. No other authors have anything to disclosure.
IRB approval
This study was performed following approval by the Johns Hopkins Medicine (JHM) Institutional Review Board (IRB), granted on October 13, 2021 (IRB00303967). This research was conducted under a waiver of consent (45 CFR 46.116) granted based on the following criteria: (1) the research involves no more than minimal risk to subjects; (2) the waiver will not adversely affect the rights and welfare of the subjects; (3) the research could not be practicably carried out without the waiver; and (4) the IRB will advise you if it is appropriate for participants to be provided with additional pertinent information after participation. This study was performed in line with the principles of the Declaration of Helsinki.
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Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Data Availability Statement
The datasets generated during and/or analyzed during the current study are not publicly available as they contain identifiable information, but are available from the corresponding author on reasonable request.