Abstract

Introduction

Gender inequality occurs in all spheres of society, which is no different in the medical field. Abstract presentations in congress are the vanguard of scientific knowledge, an integral part of topic discussion, and, ideally, culminate in the publication of these works as complete manuscripts.

Objective

The objective of this study is to evaluate the role played by women in the presentation of scientific works at the Brazilian Society of Coloproctology congress and in the works published from these presentations.

Methods

The bibliometric evaluation of the presented abstracts in the editions from 2015 to 2018 of the Brazilian Congress of Coloproctology was used, along with the works later published from these presentations. Gender identification data was extracted from the authors of the abstracts through their names and research for conference on the Lattes and Google Scholar platforms. The collected data was on the number of female participants and their order of authorship of abstracts and publications, evaluating possible changes when publication occurs.

Results

Atotal of 1,336 abstracts were analyzed, with 91.6% of female authors. When publication occurs, women’s presence dropped to 75.2% and suffered a change of order in the position of authorship to one of lesser relevance in 38.1%.

Conclusion

Women’s participation occurs in most abstracts. However, this proportion undergoes unfavorable changes when these works are published, either by changing the order of authorship, when women leave main positions and become coauthors, or are removed from the complete manuscript’s publication.

Keywords
descriptors; women; colorectal; manuscripts; gender

Introduction

Gender inequality is prevalent in many social spheres, including the medical field. Female leadership is limited even in specialties where women predominate, such as pediatrics, obstetrics, and gynecology, where there is still a higher male influence in management and leadership positions, such as full professors, department heads, and coordinators.¹1 Weinacker A, Stapleton RD. Still a man’s world, but why? Crit Care 2013;17(01):113. Doi: 10.1186/cc11915
https://doi.org/10.1186/cc11915... , ²2 West JD, Jacquet J, King MM, et al. The role of gender in scholarly authorship. PLoS One 2013;8(07):e66212. Doi: 10.1371/journal. pone.0066212
https://doi.org/10.1371/journal. pone.00... Women in surgical specialties may face implicit biases that can subtly create an environment of exclusion, discouraging them from pursuing academic positions.³3 Davids JS, Lyu HG, Hoang CM, et al. Female Representation and Implicit Gender Bias at the 2017 American Society of Colon and Rectal Surgeons’ Annual Scientific and Tripartite Meeting. Dis Colon Rectum 2019;62(03):357–362. Doi: 10.1097/DCR.0000000000001274
https://doi.org/10.1097/DCR.000000000000... For example, in the United States, in 2019, there were 520 female surgery professors, compared with 3,512 male professors.⁴4 Padmanaban V, DaCosta A, Tran A, et al. Closing the Gender Gap in Global Surgery: Trends at the Academic Surgical Congress. J Surg Res 2021;257:389–393. Doi: 10.1016/j.jss.2020.08.027
https://doi.org/10.1016/j.jss.2020.08.02... Oncologic and cardiothoracic surgery areas also exhibit the same imbalance, which will also be observed in the present study within Coloproctology.¹1 Weinacker A, Stapleton RD. Still a man’s world, but why? Crit Care 2013;17(01):113. Doi: 10.1186/cc11915
https://doi.org/10.1186/cc11915... , ⁴4 Padmanaban V, DaCosta A, Tran A, et al. Closing the Gender Gap in Global Surgery: Trends at the Academic Surgical Congress. J Surg Res 2021;257:389–393. Doi: 10.1016/j.jss.2020.08.027
https://doi.org/10.1016/j.jss.2020.08.02...

This unequal pattern is also described in scientific publications, both in Brazil and in international studies.⁵5 Zaza N, Ofshteyn A, Martinez-Quinones P, et al. Gender Equity at Surgical Conferences: Quantity and Quality. J Surg Res 2021; 258:100–104. Doi: 10.1016/j.jss.2020.08.036
https://doi.org/10.1016/j.jss.2020.08.03... Scientific publication serves as a marker of productivity and academic quality, enabling professional growth. An American study reviewing 560 manuscripts found that women accounted for only 24.8% of first authors and 16.3% of last authors of articles, both positions being prominent in authorship.⁶6 Bernardi K, Lyons NB, Huang L, et al. Gender Disparity Among Surgical Peer-Reviewed Literature. JSurg Res 2020;248:117–122. Doi: 10.1016/j.jss.2019.11.007
https://doi.org/10.1016/j.jss.2019.11.00...

The objective of this study is to assess the scientific role played by women the Coloproctology surgical specialty in scientific works presented at the Brazilian Congress of Coloproctology, compared with works published after these presentations. Despite women now constituting more than half of medical school graduates, gender inequality remains significant when it comes to leadership roles, especially in surgical specialties.

Methods

This is a descriptive study that conducts a review of scientific abstracts presented at national Coloproctology congresses from 2015 to 2018 and published in their proceedings. Using a bibliometric approach, two different examiners utilized a standardized form to collect data, which was then tabulated using the Excel 2019 (Microsoft Corp. Redmond, WA, USA). The study also evaluated works that were published in peer-reviewed journals, identified through a standardized search in the databases MEDLINE (PubMed), SciELO, and Google Scholar (Google LLC., Mountain View, CA, USA).⁷7 Denadai R, Pinho AS, Samartine H, et al. Conversion of Plastic Surgery meeting abstract presentations to full manuscripts: a brazilian perspective. Rev Col Bras Cir 2017;44(01):17–26. Doi: 10.1590/0100-69912017001008
https://doi.org/10.1590/0100-69912017001... , ⁸8 Nascimento S, Rahal RMS, Soares LR, et al. Publication rate of scientific papers presented at the largest event on breast cancer research in Latin America. Ecancermedicalscience 2021;15:1259. Doi: 10.3332/ecancer.2021.1259
https://doi.org/10.3332/ecancer.2021.125...

Data on author identification in the abstracts were extracted through searching their names and were verified through searches on the Lattes platform and Google Scholar. Through this research, the number of women authors and their classification were determined, followed by a comparison of whether this number was maintained or not when the work was published. The position of their names as first or last authors and other analyses derived from this data were also specified. By doing so, the information was compiled and used to produce the analyses described in this study (►Fig. 1).

After data gathering, a statistical analysis of the results was conducted, including quantitative and qualitative descriptive analysis of the collected data, confidence intervals, comparative analysis of variables, multivariate logistic regression test, data comparison, equality of two proportions, chi-square test, bivariate analysis, and a p-value of 0.05 was considered significant.

Due to the use of secondary data from the annals of the Brazilian Congress of Coloproctology and published articles, there was no need for evaluation and approval by an ethics committee for this article.

Results

Over the course of 4 years, from 2015 to 2018, a total of 1,336 abstracts presented at the Brazilian Congress of Coloproctology were analyzed. Among these, 1,169 (64.6%) were in the poster category, and the remaining 35.4% were in the oral category. It is important to note that works from the video presentation category were excluded from the sample. There was heterogeneity in the number of abstracts presented over the years, including variations in the presentation format, with the poster category having the highest number of entries.

Considering the analysis of all works presented, women were involved in 91.6% of the abstracts. The average number of authors per work is 6.7, and the average number of female authors is 2.5, with a growing trend of female authorship over the years. Nevertheless, women occupied the positions of first and last authors, regardless of the presentation category (poster/oral), in 51.9 and 26.9% of the congress abstracts, respectively (►Table 1).

When analyzing the abstracts that were published as full articles, there is a global decline to 75.2% in the presence of women upon publication, with a statistically significant difference between the two groups (►Table 2).

When comparing the abstract presented at the congress with the article subsequently published based on it, a change in the order/position of authors was observed in 85.1% of cases. In the case of female authors, there was a change in the order for those who held prominent positions, meaning they were no longer listed as first or last authors, or were excluded from the work, in 38.1% of cases. There is also a significant decrease in the number of women when the research is published, as shown in ►Table 3.

In ►Table 4, we can observe the prevalence ratio of 0.37 (0.24-0.57) for the presence of women as authors or coauthors. This ratio indicates that the presence of women is a negative factor for the abstract presented at the congress to become a publication.

Discussion

The disharmony in the division of domestic activities, with the expectation for women to fulfill roles as mothers andwives,alongwiththechallengesintheirprofessional lives, can also hinder their involvement in scientific activities. Even today, roles that are equally performed by men and women are unequally valued by society, including in the medical and scientific fields. This is due to the existence of a patriarchal society that deprived womenof accesstouniversitiesand scienceuntil themid-19th century.²2 West JD, Jacquet J, King MM, et al. The role of gender in scholarly authorship. PLoS One 2013;8(07):e66212. Doi: 10.1371/journal. pone.0066212
https://doi.org/10.1371/journal. pone.00... Elizabeth Blackwell was the first woman in the world to graduate as a medical doctor, in 1838, and in Brazil, it was only in 1879 that a decree allowed women to attend colleges and obtain academic degrees. Finally, Rita Lobato became the country’s first female medical doctor in 1887.⁹9 Martins APV. Women, male doctors, and female historians: a historiographic essay on the history of women, medicine, and gender. Hist cienc saude-Manguinhos. 27(01):241–264. Doi: 10.1590/S0104-59702020000100014
https://doi.org/10.1590/S0104-5970202000...

The latest Brazilian Medical Demographic Census, conducted in 2020, revealed that women represent 32% of specialists in Coloproctology.¹⁰10 Scheffer M. et al. Demografia Médica no Brasil. FMUSP: CFM. 2020. ISBN: 978–65–00–12370–8 Despite this, a study that evaluated four major annual surgery conferences (The Eastern Association for the Surgery of Trauma, Society of American Gastrointestinal and Endoscopic Surgeons, Academic Surgical Conference, and the American Society of Breast Surgeons) observed that out of 1,388 participants, only 28% of the speakers were women.⁵5 Zaza N, Ofshteyn A, Martinez-Quinones P, et al. Gender Equity at Surgical Conferences: Quantity and Quality. J Surg Res 2021; 258:100–104. Doi: 10.1016/j.jss.2020.08.036
https://doi.org/10.1016/j.jss.2020.08.03... Another American study in Coloproc-tology pointed out that since the founding of the American Society of Colon and Rectal Surgeons (ASCRS) in 1899, the presidency has only been held by women twice.³3 Davids JS, Lyu HG, Hoang CM, et al. Female Representation and Implicit Gender Bias at the 2017 American Society of Colon and Rectal Surgeons’ Annual Scientific and Tripartite Meeting. Dis Colon Rectum 2019;62(03):357–362. Doi: 10.1097/DCR.0000000000001274
https://doi.org/10.1097/DCR.000000000000...

In this study, the presence of women in abstracts presented at the Coloproctology Congress from 2015 to 2018 ranged from 87 to 94.5%, with an average of 91.6% over the entire period. A study conducted during the Academic Surgical Congress⁴4 Padmanaban V, DaCosta A, Tran A, et al. Closing the Gender Gap in Global Surgery: Trends at the Academic Surgical Congress. J Surg Res 2021;257:389–393. Doi: 10.1016/j.jss.2020.08.027
https://doi.org/10.1016/j.jss.2020.08.02... showed an increase in the number of early-career female first authors in the last 40 years. However, other studies reinforce that women are still a minority in authoring original research articles and as members of journals’ editorial boards.¹¹11 Camargo JRFd. Hayashi MCPI. Coautoria e participação feminina em periódicos brasileiros da área de cirurgia: estudo bibliométrico. RDBCI: Revista Digital de Biblioteconomia e Ciência da Informação. 2017;15(01). Doi: 10.20396/rdbci.v15i1.8646289
https://doi.org/10.20396/rdbci.v15i1.864... , ¹²12 Jagsi R, Guancial EA, Worobey CC, et al. The “gender gap” in authorship of academic medical literature-a 35-year perspective. N Engl J Med 2006;355(03):21–287. Doi: 10.1056/NEJMsa 053910
https://doi.org/10.1056/NEJMsa 053910... , ¹³13 Jonasson O. Leaders in American surgery: where are the women? Surgery 2002;131(06):672–675. Doi: 10.1067/msy.2002.124880
https://doi.org/10.1067/msy.2002.124880... , ¹⁴14 Martins Mda C, Carneiro MG, Utzig JB, et al. Scientific output of Brazilian dermatologists during the last 25 years in the five highest impact factor journals in dermatology. An Bras Dermatol. 2012;87 (05):714–6. DOI: Doi: 10.1590/s0365-05962012000500007
https://doi.org/10.1590/s0365-0596201200... , ¹⁵15 Morton MJ, Sonnad SS. Women on professional society and journal editorial boards. J Natl Med Assoc 2007;99(07):764–771, ¹⁶16 Amrein K, Langmann A, Fahrleitner-Pammer A, et al. Women underrepresented on editorial boards of 60 major medical journals. Gend Med 2011;8(06):378–387. Doi: 10.1016/j.genm.2011.10.007
https://doi.org/10.1016/j.genm.2011.10.0... The field of Vascular Surgery has the highest female academic production.¹⁷17 Valsangkar N, Fecher AM, Rozycki GS, et al. Understanding the Barriers to Hiring and Promoting Women in Surgical Subspecialties. J Am Coll Surg 2016;223(02):387–398.e2. Doi: 10.1016/j. jamcollsurg.2016.03.042
https://doi.org/10.1016/j. jamcollsurg.2...

The first author position in a scientific article is typically occupied by the person who made the most significant contribution to the research, essentially whoever is considered the project’s lead author. On the other hand, in congress presentations, the first author position is often associated with the presenter rather than the principal author.²2 West JD, Jacquet J, King MM, et al. The role of gender in scholarly authorship. PLoS One 2013;8(07):e66212. Doi: 10.1371/journal. pone.0066212
https://doi.org/10.1371/journal. pone.00... , ¹⁸18 Hilário CM, Cabrini Grácio MC, Martínez-Ávila D, Wolfram D. ¿Existe una justificación para el orden de los autores en la mención de autoria? Un estudio de caso de la investigación en informetría. Rev Esp Doc Cient 2022;45(03):e335. Doi: 10.3989/redc.2022.3.1890
https://doi.org/10.3989/redc.2022.3.1890... , ¹⁹19 Petroianu A. Criteria for authorship and evaluation of a scientific paper. Arch Clin Psychiatry (São Paulo). 37(01 ):1–5. Doi: 10.1590/S0101-60832010000100001
https://doi.org/10.1590/S0101-6083201000... In our research, we observed a certain balance between men and women: in 2015, of the presented abstracts, 53.6% had women as the first author. In the following years, the statistics remained similar: 48.3 (2016), 49.8 (2017), and 58.1% (2018). However, the total number of works with 6 or more female authors during the period was only 3.8%, indicating that despite the inclusion of these women, male authors are still predominant.

When the presented abstracts are published, our study demonstrated that the presence of women as authors decreases from 91.6 to 75.2%. The total number of women in published works also decreased. Moreover, there was a decline in the distribution of the categories of the number of female authors (2–3 and 4–5) among the published works.

Furthermore, positions of relevance (first or last author) also undergo changes, with 38.1% of the abstracts that were published showing alterations in the order of the first and last female authors to a less prominent position or exclusion. The reason behind this change in order is intriguing, as it may occur due to various factors, such as loss of interest by the authors, modification of the criteria, assignment of the first name to someone who will solely present the work, changes in the involvement of these women throughout the research and article construction, or even a structural change influenced by male dominance, as scientific publication brings more prestige and results than an abstract presented at conferences. Addressing these issues is crucial to promote gender equality and ensure fair recognition for female researchers’ contributions in the scientific community.

Some studies show that despite women being roughly equal in numbers to men, when analyzed as last authors, there is still inequality.²2 West JD, Jacquet J, King MM, et al. The role of gender in scholarly authorship. PLoS One 2013;8(07):e66212. Doi: 10.1371/journal. pone.0066212
https://doi.org/10.1371/journal. pone.00... Other analyses describe women as the minorityin authorship when it comes to original research articles,¹¹11 Camargo JRFd. Hayashi MCPI. Coautoria e participação feminina em periódicos brasileiros da área de cirurgia: estudo bibliométrico. RDBCI: Revista Digital de Biblioteconomia e Ciência da Informação. 2017;15(01). Doi: 10.20396/rdbci.v15i1.8646289
https://doi.org/10.20396/rdbci.v15i1.864... or topics related to surgical techniques.⁵5 Zaza N, Ofshteyn A, Martinez-Quinones P, et al. Gender Equity at Surgical Conferences: Quantity and Quality. J Surg Res 2021; 258:100–104. Doi: 10.1016/j.jss.2020.08.036
https://doi.org/10.1016/j.jss.2020.08.03...

In the surgical field, studies show there is still low representation of women in mentoring and leading scientific research, which is evident in the finding of a smaller proportion of women as last authors. A study evaluated an American congress (Academic Surgical Congress) and concluded that for every female author of abstracts, there are approximately three male last authors, a significant difference, especially in the fields of oncologic and cardiothoracic surgery.⁴4 Padmanaban V, DaCosta A, Tran A, et al. Closing the Gender Gap in Global Surgery: Trends at the Academic Surgical Congress. J Surg Res 2021;257:389–393. Doi: 10.1016/j.jss.2020.08.027
https://doi.org/10.1016/j.jss.2020.08.02... In our study, the rate of works with women as last authors was low, varying from 24 to 33.7%.

Another interesting finding in the multivariate analysis was that the presence of women is associated with non-publication, Prevalence ratio (PR): 0.37 (0.24–0.57), meaning there is a lower chance of publication when women are involved in the work.

Although in increasing numbers, women must be credited and encouraged to lead institutions, conduct research, guide articles and studies, speak about scientificand social subjects, and, above all, influence other women to do the same. It is known that the medical and surgical environment, as well as the daily life of institutions, are important factors in bringing women to the goals discussed here. Furthermore, even today, there is much disrespect, disbelief, and contempt for women’s productions.

In short, as a historical and recent issue, the presence and role of women in science must be constantly evaluated, discussed, and respected until there is equality in all areas of society, from small spheres to positions of power. To achieve this, it is necessary to provide them with more visibility, attention, and opportunities.

Limitations

We assess that this is a groundbreaking work in the field of Brazilian Coloproctology, but some limitations need to be highlighted: we evaluated the proportional contribution of women through abstracts presented at congresses and manuscripts published based on these presentations. However, the quality of the abstracts that included female authors was not under analysis.

The order of authors can vary for various reasons in conference abstracts and scientific articles, and often the selection criterion for the first author might be the simple fact that they were the presenter at the event. Additionally, no investigation was performed on women whose authorship order was changed or who were excluded from publications later on. Future studies could address the gaps mentioned above, considering that this work was limited to the analysis of quantitative data.

It is also possible that research has been published as full manuscripts during the years analyzed and had greater participation of women without necessarily being presented at the evaluated Coloproctology congresses. Therefore, it is essential to encourage further audit studies to control and better assess what has been presented at conferences and/or by whom (male and female authors). Part of this work could even be initiated by the medical societies themselves with the aim of improving the scientific content of their events.

Conclusion

The data found in this research demonstrate that women’s participation occurs in the vast majority of works presented in the form of abstracts at the Brazilian Coloproctology congress. However, this proportion undergoes unfavorable changes when these abstracts are published, either through changes in authorship order, where women shift from principal positions to coauthors, or even when they are not included in the publication of the full manuscript. Additionally, based on the statistical analysis conducted, it was concluded that the presence of women as fi rst or last authors is a factor associated with nonpublication, exerting a negative influence in this regard.

Acknowledgments

We appreciate the support and support of the Pontifícia Universidade Católica de Campinas (PUC Campinas) for creating a thriving environment for research and the development of the academic environment for professors and students.

References

Publication Dates

History