More Women Giving Grand Round Lectures

The number of women cardiologists presenting at grand rounds has increased steadily over 25 years in the United States, but in some subspecialties, women grand round speakers remain markedly underrepresented, according to the first published study on the topic.

Ersilia M. DeFilippis, MD, with the Center for Advanced Cardiac Care at Columbia University Irving Medical Center, New York City, led the study published online in JAMA Cardiology.

Of the 626 internal medicine residency programs in the United States, 42 had data available for analysis. Researchers included grand round speakers from September 1997 through December 2022. Grand rounds with more than one speaker and trainee-led case conferences were excluded.

About 1% Growth Each Year for 25 Years

The team found that among the total of 3,806 grand round lectures, 21% were given by women and 79% by men. The number of women grand round speakers increased by 1% per year and increased for each topic 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 less than .001).

According to Association of American Medical Colleges 2018-2019 data, 21% of cardiology faculty at US medical schools were women, though the percentage of women cardiologists in practice is estimated at 12.6%-14%.

“Our data suggest that the proportion of grand round lectures delivered by women is commensurate with the US cardiology workforce,” the authors wrote.

Senior author Nosheen Reza, MD, assistant professor of medicine in the Division of Cardiovascular Medicine and director of the Penn Women in Cardiology Program at the Perelman School of Medicine at the University of Pennsylvania in Philadelphia, told Medscape Medical News “we were heartened to see growth, albeit very small growth, but positive signals toward more women speakers over time.”

She cited significant gains in the number of women delivering grand rounds on women’s cardiovascular health, a newer subspecialty within cardiology and the overall growth in interest in that topic

The number of women delivering grand rounds on electrophysiology and basic, translational science was disappointing, “and those are specific areas where we should try to elevate women’s voices,” she said.

Study Grew from an Internal Realization

Reza started the Penn Women in Cardiology Program and one of the early projects was looking internally at the number of women cardiologists delivering grand rounds.

“Internally, we were only inviting about 10%-11% of (women speakers). I thought, obviously we could do much better than this,” Reza said.

So they worked with the grand round speaker invitation committee to provide names of outstanding women cardiologists who may have even given grand round lectures elsewhere, but had not been invited internally.

“We saw very quickly — within 2-3 years — that actually we completely flipped the representation and there were a couple of years when we had 50%-55% of women speakers,” she said. That led to looking at the numbers nationally.

The grand rounds metric is significant, she pointed out, because lecturing in grand rounds can help women build relationships, gain sponsorships, raise their professional profile, and further in their careers.

Male cardiologist allies are also needed to increase the number of women grand round speakers as they make up most of the leadership deciding who gets invited to speak, Reza said.

Mary N. Walsh, MD, medical director of the Heart Failure and Cardiovascular Research Institute at Ascension St. Vincent Heart Center in Indianapolis, and past president of the American College of Cardiology, told Medscape Medical News the good news in these results is the steady 1% growth over time.

She said two main limitations of the study should be considered. One is that only 42 of the 626 training programs had data available for analysis.

“It’s a sample,” Walsh said, and it’s unclear whether the results would be the same if data were more widely available.

How Many Accept the Invitation?

Probably the most important question that can’t be addressed by these data, Walsh said, is, “Do women and men accept such invitations at the same percentage? We don’t know who was invited. You can’t assign responsibility to these institutions for how many women they have giving their grand rounds unless you know how many they invited. It’s very hard data to get.”

Another interesting analysis would be to see if there are individual outliers, whether some institutions invite almost no women cardiologists to speak at grand rounds or they invite an exceptionally high number, Walsh said.

She said the gender of grand round presenters is a novel and important metric to track. “It’s an invitation one gets generally when becoming accomplished in a field and if there’s a differential in inviting men vs women, then women aren’t being recognized for their expertise.”

Inviting a grand round speaker is highly subjective and therefore can come down to who you know, Walsh said.

She noted that one resource created to elevate the profiles of women cardiologists and their specialties is the website Women as One. If institutions are committed to increasing the number of women speaking in their grand rounds, “there’s an easy way to do it by using that directory,” Walsh said.

DeFilippis reported receiving personal fees from AstraZeneca and serving on a clinical trial committee for Abiomed outside the submitted work. Robert Harrington reported receiving research grants/contracts from the National Heart, Lung, and Blood Institute (NHLBI) (ISCHEMIA), Duke/PCORI (ADAPTABLE), Janssen, and CSL Behring; serving on a data and safety monitoring board for the Baim Institute, Colorado Prevention Center, and Merck; consulting and/or advising for the NHLBI (COVID/CONNECTS), Atropos Health, Bitterroot Bio, Bristol Myers Squibb, Bridge Bio, Chiesi, Colorado Prevention Center, CSL Behring, Edwards Lifesciences Corp, Element Science, Foresight, Merck, and WebMD; and serving on the board of directors for the American Heart Association and Cytokinetics. Nadim Mahmud reported receiving support from the National Institute of Diabetes and Digestive and Kidney Diseases and research support from Grifols. Reza reported receiving support from the NHLBI, speaking honoraria from Zoll, adviser fees from American Regent and Bristol Myers Squibb, and research grants to their institution from Bristol Myers Squibb outside the submitted work. Walsh reported no relevant financial relationships.