Getting Women More Involved at the International Stroke Conference: Theories, Data, and Solutions

HONOLULU, HI—Leaders of the International Stroke Conference (ISC), a meeting of the American Heart Association/American Stroke Association (AHA/ASA), are not shying away from an issue that has been raised at a range of recent medical meetings: inadequate female representation.

Three studies presented here—all conducted with some contribution from current members of the ISC program committee—highlighted the fact that women have been underrepresented in terms of submitted abstracts, invited speaking roles, and meeting leadership.

Presented by Lauren Fournier, MD (University of Texas Health Science Center at Houston), two of those investigations showed that across 5 years of the meeting from 2014 to 2018, women were first authors for only about one-third of submitted and accepted abstracts and accounted for only 28% of those asked to speak at invited symposia, preconference sessions, debates, and case theater presentations. Those proportions did not vary over time.

Female contributions were particularly lacking when it came to abstracts and talks from physicians as opposed to nurses and midlevel professionals like nurse practitioners and physician assistants. Participation of women was also disproportionately low in topics related to acute, in-hospital care, with better representation in areas related to stroke rehabilitation, recovery, prevention, and health services.

And a third study by Amy Guzik, MD (Wake Forest School of Medicine, Winston-Salem, NC), looked into the number of women in ISC leadership roles, including program committee members, early career development leaders, award recipients, invited speakers, and session moderators.

There was major bump up in the proportion of women on the ISC program committee over time, increasing from just 14.3% in 2014 to 48.2% in 2018, but big disparities between women and men remained when looking at invited speakers, moderators, and award recipients, despite some narrowing of the gaps. “Overall, it’s still a problem,” Guzik said.

Speaking with TCTMD, Mariell Jessup, MD, chief science and medical officer of the AHA, said, “We thought it was really important to publish those abstracts because if you don’t measure it, you can’t change it.”

We thought it was really important to publish those abstracts because if you don’t measure it, you can’t change it. Mariell Jessup

The hope, according to Louise McCullough, MD, PhD (University of Texas Health Science Center at Houston), current vice chair of the ISC program committee, is that raising awareness of the problem will help spur change: “I think the fact that we’re even talking about this is something that we wouldn’t have talked about 5 years ago. Once you start paying attention to a problem, then it’s easier to find solutions.”

Bruce Ovbiagele, MD (University of California, San Francisco), a co-author of Fournier’s studies, said he encouraged his colleagues to look into the issue after noticing the shortage of women at the meeting during his tenure as ISC program committee chair in 2017 and 2018. “We need to do a much better job,” he told TCTMD, “so it was an eye-opener and it was important that we did it in a systematic way to try and figure out what was going on.”

A Multifaceted Problem

In recent years, a number of cardiology meetings have put specific measures in place to try to address the underrepresentation of women at meetings, but as Jessup said, there are probably multiple reasons to explain the shortfall.

One is that women make up less than 50% of specialists in cardiology and stroke, so when members of the program committees are sending out invitations for sessions they will more often think of men based simply on numbers.

Social factors could come into play as well. If most members of a program committee are men, they may be more likely to think of the people they know socially—probably mostly men—when recruiting people for sessions, Jessup said. “Part of that is human nature.”

In addition, “I think it’s also true that some women are reluctant to come to a meeting. Some women are more reluctant to speak publicly than men are. I think they don’t get mentored as well to do that. It may not be something they value as much as men do,” Jessup said. “I’m giving you a lot of answers, because I think there is not a single answer.”

McCullough pointed to the fact that women have traditionally made up a smaller portion of the entire pool of professionals within the field as just part of the issue. She noted that over the past 15 years, proportions of women and men in medical schools have been roughly equal. “We are balanced now, and we still—especially even at the early-career stage—are seeing a disproportionate number of men rather than women getting these presentations and posters and coming to meetings,” she said.

A bigger piece of the puzzle may be challenges with managing work/life balance and raising a family, McCullough indicated, and Fournier agreed. Committing to attending a meeting “becomes a little overwhelming when you think about how I’m going to submit my abstracts and then I will travel there if I’m going to present them and about how I do that if I have kids,” Fournier said, noting that it can be particularly challenging if a mother is still breastfeeding.

What Can Be Done?

Mentoring was a recurring theme in discussions with female physicians about how to improve the representation of women at meetings and get them more involved in science and medicine in general.

“You have to have someone to guide you through that, and you need a strong mentor, whether it’s a male or a female mentor. I’ve been really fortunate in that regard,” Fournier said, singling out McCullough and Anjail Sharrief, MD (University of Texas Health Science Center at Houston). She added that it’s important to have support “even from a young age to continue to pursue science because it’s just been so typically a male-dominated thing.”

McCullough indicated that mentoring can help women who are starting out to realize the importance of asking to be placed in leadership positions, moderating sessions, giving talks, or working toward achieving FAHA (Fellow of the AHA) status.

To that end, ISC leadership has made efforts to introduce more formal mentoring opportunities at the annual meeting. This year’s meeting, for example, included a luncheon where female fellows and early-career professionals could ask women leaders about various career issues, as well as a town hall forum for women working in the stroke field that covered topics like managing work/life balance and the right way to ask for a raise.

If you don’t come to a conference for 3 or 4 years when your kids are young, that’s really dangerous in the early stage of your career when you’re supposed to be networking and meeting people. Louise McCullough

“As women in more-established roles, we need to take responsibility to reach out to those women and get them up and involved early, and say, ‘This is important that you do this,’” McCullough said. “And so I think really paying attention to trying to provide resources for them—especially as far as juggling the family, getting them to be more assertive about asking for leadership roles, and teaching them how to become young leaders—is going to be really important.”

As for overcoming the family issues that might be holding some women back, McCullough pointed out that the AHA is working on it. For instance, there were nursing mother rooms at this year’s ISC and the AHA has committed to providing on-site day care next year, she said—something the European Society of Cardiology was hailed for providing, prominently, at its 2018 meeting. “So they realize this is a problem and they don’t want those barriers,” she said.

Enabling women to get to meetings, particularly early in their careers, is an important way to address some of the observed disparities, McCullough said. “Because if you don’t come to a conference for 3 or 4 years when your kids are young, that’s really dangerous in the early stage of your career when you’re supposed to be networking and meeting people,” she explained. “If you don’t come until you’re midcareer, you’re way behind.”

‘Change Takes Time’

Fournier said she’s hopeful that women will be better represented in the future because even though about one-third of full professors in neurology are women, 44% of spots in residency programs for neurology were filled by women in 2017.

“So the future, I think, is bright,” she said. “People are bringing this to light and I’m hoping that we can continue to see that going forward.”

McCullough had a positive outlook, too.

“I’m very optimistic, especially because so many people have really gotten behind this—men and women, senior mentors, junior mentors,” she said. “We had several networking opportunities specifically for women in medicine and science throughout the program and that’s occurring everywhere. Not just through the AHA. Every meeting is now doing this because they’re realizing that diversity brings good ideas.”

Jessup highlighted the need for purposeful effort to help address this and other problems with representation.

“For instance, at the AHA, when we were planning for Scientific Sessions, we told the program committee we will not accept a program that doesn’t have any women. We will not accept a program that doesn’t have any international people. We will not accept a program that hasn’t made a real attempt to find underrepresented minorities in addition to women,” she said. “So you have to set some standards like anything else that you’re trying to accomplish. That’s the beginning.”

Jessup said she has already seen some progress in recent years across meetings, pointing to the efforts of the European Society of Cardiology’s first female president, Barbara Casadei, MD, DPhil (University of Oxford, England), and others.

As for how the situation will look in 5 years or so, Jessup was hopeful but noted, also, that the #MeToo movement has shown that there can be pushback from such efforts.

“So I hope it’ll get better,” Jessup said. “At the American Heart Association, and obviously the American Stroke Association, we’re really committed to it and [we] are working hard, but change is hard and change takes time.”

Photo Credit: American Heart Association