Literature DB >> 35077466

Representation of women at American Psychiatric Association annual meetings over 10 years (between 2009 and 2019).

Sabrina Sebbane1, Sophie Bailly1, Wayne-Corentin Lambert2, Stéphane Sanchez3, Coraline Hingray4,5, Wissam El-Hage1,6.   

Abstract

OBJECTIVE: Sex disparity is a major societal issue. The aim of this paper was to describe changes in the representation of women among speakers of the American Psychiatric Association (APA) annual meeting over 10 years, between 2009 and 2019 and to compare them to changes in the proportion of women among American psychiatrists.
METHODS: Data were collected from the programs of the APA annual meetings of 2009 and 2019, and from the Association of American Medical Colleges. Descriptive and comparative statistical analyses were performed.
RESULTS: There were 1,138 distinct speakers at the 2009 conference and 1,784 at the 2019 conference. The number of distinct female speakers increased from 413 (36.3%) to 813 (45.6%). The proportion of female speakers at the meetings was almost equivalent to the proportion of women in the American psychiatrists' workforce. The number of female chairs increased from 158 (39.6%) to 322 (46.4%). There were 38 female speakers in child and adolescent psychiatry in 2009 (51.4% of 74 speakers) and 74 in 2019 (51.0% of 155 speakers).
CONCLUSIONS: The representation of women at the APA annual meetings increased between 2009 and 2019. At the same time, the growth in the percentage of women in the American psychiatrists' workforce was slower. The APA appears to promote female representation during its annual meetings.

Entities:  

Mesh：

Year:  2022        PMID： 35077466      PMCID： PMC8789168          DOI： 10.1371/journal.pone.0261058

Source DB:  PubMed          Journal:  PLoS One        ISSN： 1932-6203            Impact factor:   3.240


Introduction

As we live in an era promoting sex equity in multiple ways, this question is also extensively studied in healthcare, in particular for healthcare providers [1] and in research [2]. Since the first woman to officially study in an American medical school in 1847 [3], the rates of female physicians have increased markedly, including in psychiatry. Indeed, approximately 40% of active psychiatrists and 50% of active child and adolescent psychiatrists in the United States (US) were women in 2017 [4]. In academic psychiatry, women are now more represented as faculty, but are still underrepresented in leadership roles such as department chair [5]. Annual meetings of scientific societies are major events for physicians, and speaking during these meetings is a good way to promote their work and increase their professional visibility. Studying the rate of women speaking during these meetings could be an interesting way to evaluate their representation and visibility in their field. Also, studying sex disparity could in itself improve sex equity [6]. Previous studies have shown an underrepresentation of women at academic meetings [7-17]. The gap between the percentage of women in the workforce and the percentage of women among speakers, however, seems to decrease with time [7, 9, 15, 18]. Several medical specialties have studied female representation at their annual meetings. For instance, studies showed that sex equity among speakers was achieved in 2015 at the microbiology meeting [6]. In contrast, annual neurosurgery meetings failed to reach sex equity among speakers [19] as in hip and knee surgeon annual meeting [16]. In psychiatry, we found only two studies, which demonstrated that female representation at the French and Australian annual meetings improved over the years [20, 21]. While the proportion of female speakers at the Victoria Branch Conference evolved from one to four in seven between 2013 and 2014, women were still underrepresented at the French annual meeting in 2018 [20, 21]. The American Psychiatric Association (APA) is the world’s most prominent psychiatric organization [22]. It openly promotes equity [23] and has published a position statement indicating its intent to increase the representation of Women in Psychiatry (WIP) in leadership roles [24]. Silver et al. [25] examined sex disparity in medical society leadership between 2008 and 2017. They showed that the APA was one of the few medical societies that had achieved sex equity for leadership [25]. Larson et al. [7] showed that WIP were underrepresented among speakers at the APA meeting between 2013 and 2017. However, their study analyzed female representation only among keynote and plenary speakers and invited lecturers [7]. No study to date has analyzed changes in sex disparity among all the APA meeting speakers over an extended period of time. The aim of this paper was to describe changes in the representation of women among speakers at APA meetings between 2009 and 2019. Another objective was to describe changes in the various roles, the different topics and the different sessions presented in the programs. Finally, we wanted to compare female representation at the APA meetings to female representation in the US psychiatric workforce.

Methods

This retrospective, cross sectional study evaluated the evolution of the representation of female speakers at the 2019 APA annual meeting compared to the 2009 APA annual meeting. This work also analyzed sex distribution for each role, session and topic described in the meetings. Finally, female speakers representation at the APA meetings was compared to female representation in the US psychiatric workforce.

Study sample

The programs of the APA annual meetings of 2009 and 2019 were analyzed to accurately collect, for each speaker, four main variables: i) Sex; ii) Role: chairs, presenters, lecturers, directors, faculty and discussants; iii) Session: general sessions, courses, presidential sessions, workshops, master courses and special sessions; iv) Topic of the session: addiction psychiatry, child and adolescent psychiatry, consultation-liaison psychiatry, diversity and health disparity, forensic psychiatry, geriatric psychiatry, residents, fellows, and medical students.

Variables

We collected the roles for each speaker. There were some dissimilarities in types of roles between 2009 and 2019 programs. For comparison purposes, we gathered some types of roles under the same terminology (Table 1). The following terminology was used to classify the types of roles: chair, director, faculty, discussant and presenter. We distinguished presenters of special sessions from the overall presenters as these speakers appeared to be in the spotlight.
Table 1

Terminology matching between 2009 and 2019.

20092019Used terminology
Roles
Chair, Vice-chairChair, HostChair
DirectorDirectorDirector
FacultyFacultyFaculty
DiscussantDiscussantDiscussant
Participant, Presenters, Pro/con-side, Moderator, Panelist, Not specifiedPresenter, Pro-con, Moderator, Not SpecifiedPresenter
Sessions
LecturePresidential sessionPresidential session
Master coursesMaster coursesMaster courses
Mindgames, Special EventSpecial sessionSpecial session
WorkshopLearning Lab, Media SessionWorkshop
Symposium, Advances in … series, Case conferences, Forums, Scientific and Clinical report session, Medical updatesGeneral sessionSymposium
CoursesCoursesCourses
Topics
Addiction psychiatry, Alcohol and drug related disorders, Eating disorderAddiction psychiatry, NIDA research trackAddiction psychiatry
Attention spectrum disorder, Child and adolescent psychiatry and disordersChild and adolescent psychiatryChild and adolescent psychiatry
AIDS and HIV Related disorders, Pain management, Sleep disordersConsultation-liaison psychiatryConsultation-liaison psychiatry
Cross-cultural and minority issues, Ethics and human rights, Gender issues, Lesbian gay bisexual transgender issues, Religion, spirituality and psychiatry, Social and community psychiatry, Stigma advocacyDiversity and health disparityDiversity and health disparity
Psychiatric education, Resident and medical students concernsResident, fellows and medical studentsResident, fellows and medical students
Forensic psychiatryForensic psychiatryForensic psychiatry
Geriatric psychiatryGeriatric psychiatryGeriatric psychiatry
Other*UnspecifiedOther topics

* Sessions from the “other” topic from 2009 were classified one by one with the most relevant 2019 topic according to their name, if no 2019 topics matched, they were classified as “other topics”.

* Sessions from the “other” topic from 2009 were classified one by one with the most relevant 2019 topic according to their name, if no 2019 topics matched, they were classified as “other topics”. Similarly, we collected speakers sex information from the different types of sessions in the programs. For comparison purposes, we also pooled some types of sessions under the same terminology (Table 1). The following terminology was used to classify the types of session: presidential session, master course, special session, workshop, symposium and course. The main topic of each session was mentioned in the 2019 program. As some of the topics mentioned in 2009 did not match those in 2019 and were more complex, the authors decided after collegiate discussion to assign one of the 2019 topics to a part of the 2009 sessions. Sessions with no topic mentioned or no topic corresponding to the list were labeled as “other topics”. The following terminology was used to classify the topics: addiction psychiatry, child and adolescent psychiatry, consultation-liaison psychiatry, diversity and health disparity, forensic psychiatry, geriatric psychiatry, residents, fellows, and medical students. Some sessions mentioned two different topics. The sex of the speakers was identified using their first and last names, combined with an Internet search, which was necessary to confirm cases for which direct identification was not possible. Sex identification was performed by one author, then verified by a second one to avoid wrong sex assignment. Finally, as some speakers spoke in several sessions, each speech was counted and defined. National demographic data were obtained from the website of the Association of American Medical Colleges and the Accreditation Council for Graduate Medical School. We collected data for the 2010–2019 active WIP and child and adolescent psychiatry in the US as 2009 data was not available. The percentage of female residents and fellows in psychiatry and child and adolescent psychiatry in the US in 2009 and 2019 was collected.

Statistics

We first performed a descriptive analysis. We calculated the percentage of female speakers in the 2009 and 2019 APA annual meetings. We calculated the total percentage of female speakers for each year and then for each type of session, role and topic. For each year, we performed a comparative analysis to determine whether the percentage of women speakers was different from 2009 compared to 2019, overall and for each category. Then, we performed a multivariable analysis by logistic regression, evaluating the probability of female participation according to role, type of session, topic and APA year (2019 vs 2009). The variables to be included in the logistic regression model were selected to reflect the main differences in congress structure between 2009 and 2019. The analysis was conducted using R version 4.0.2 (www.R-project.org).

Results

General data

We describe the change in the percentage of female speakers at the 2009 and 2019 APA annual meetings, according to the inclusion criteria described above. We identified 1,138 and 1,784 distinct speakers at the 2009 and 2019 APA meetings, respectively. The number of female speakers increased from 413 (36.3%) to 813 (45.6%), and was almost equivalent to the proportion of active female psychiatrists in the US. Indeed, the percentage of active female psychiatrists in the US was of 37.1% in 2010 and 42.9% in 2019. The proportion of female residents and fellows in psychiatry, however, decreased from 51% to 48.9% between 2009–2010 and 2019–2020. This suggests that the percentage of female speakers at the APA annual meetings was slightly higher than the percentage of active female psychiatrists during the approximately same decade. Females intervened in 522 (31.4%) and 926 sessions (40.6%) in 2009 and 2019 respectively, while males intervened in 1,139 (68.6%) and 1,355 (59.4%) sessions. The number of interventions per speaker decreased for both genders: from 1.26 to 1.14 interventions per speaker for women and from 1.57 to 1.40 interventions per speaker for men.

Roles

Here we describe the representation of female speakers among chairs, directors, faculty, discussants and presenters. The number of female chairs increased from 158 (39.6%) to 322 (46.4%) from 2009 to 2019. There were 286 (36.9%) female presenters in 2009, and 721 (46.5%) in 2019. Although the role of director was less frequent in 2019, a higher proportion of women exerted it that year: the number of female directors changed from 24 (20.7%) to 12 (25.5%): The number of female faculty increased from 47 (34.8%) to 48 (42.9%). There were 6 (27.3%) female discussants in 2009, and 36 (40.9%) a decade later (Fig 1A and 1B). The role was not defined for one female speaker in 2009 and one male speaker in 2019.
Fig 1

A. Rate of women per role, 2009 versus 2019. B. Change in rate of women per role.

A. Rate of women per role, 2009 versus 2019. B. Change in rate of women per role.

Topics

Here we describe the representation of female speakers for selected topics found in the 2009 and 2019 APA conferences: addiction psychiatry; child and adolescent psychiatry; consultation-liaison psychiatry; diversity and health disparity; forensic psychiatry; geriatric psychiatry; residents, fellows, and medical students. Each of the 3,942 interventions were assigned to one (96.3%) or two (3.7%) main topics. The percentage of female speakers in child and adolescent psychiatry sessions remained stable: 38 women (51.4%) in 2009 and 79 women (51.0%) in 2019. The number of female speakers in consultation-liaison psychiatry sessions increased from 44 (34.9%) to 45 (44.1%). The percentage of female speakers at the APA diversity and health disparity sessions increased from 104 (44.4%) to 125 (55.1%). Likewise, the proportion of female speakers in forensic psychiatry was higher in 2019 (77 women; 42.5%) than in 2009 (34 women; 29.1%). The number of female speakers in geriatric psychiatry increased from 15 (39.5%) to 28 (51.9%). The number of female speakers in “residents, fellows, and medical students” sessions increased from 63 to 164. However, the proportion of women in these sessions remained almost stable (52.1% and 56.7% in 2009 and 2019 respectively). However, the number of women decreased in addiction psychiatry, from 53 (39.8%) in 2009 to 43 (30.7%) in 2019. For other topics, the number of female speakers increased from 186 (29.9%) to 645 (44.1%) (Fig 2A and 2B).
Fig 2

A. Rate of women per topic, 2009 vs 2019. B. Change in rate of women per topic.

A. Rate of women per topic, 2009 vs 2019. B. Change in rate of women per topic.

Sessions

Here we describe the representation of female speakers among general sessions, courses, presidential sessions, workshops, master courses and special sessions. The number of female speakers during presidential sessions changed from 17 (35.4%) to 71 (41.0%). The number of female speakers during master courses decreased from 5 (35.7%) to 4 (19.0%). The percentage of female speakers during special sessions remained similar: 6 (42.9%) vs 10 (41.7%). Considering both genders, there were 433 speakers in workshops in 2009 and 83 in 2019. The proportion of female speakers during workshops remained stable: 197 (45.5%) in 2009 vs 46 (55.4%) in 2019. The percentage of female speakers during symposia was higher in 2019 (936 female speakers: 46.2% of speakers in this type of session) compared to 2009 (231 female speakers: 33.1% of speakers in this type of session). The proportion of female speakers in courses was higher in 2019 than in 2009 (65 or 39.7% vs 52 or 27.4%) (Fig 3A and 3B). The type of session was not defined in four cases in 2009 and in 36 cases in 2019, of which 20 were sessions presented by female participants.
Fig 3

A. Rate of women per type of session, 2009 vs 2019. B. Change in rate of women per type of session.

A. Rate of women per type of session, 2009 vs 2019. B. Change in rate of women per type of session.

Multivariable analysis

Results of the multivariable analysis are presented in Table 2. The probability of female participation increased between 2009 and 2019, with an Odds Ratio of 1.580 (95%CI 1.351–1.850, p < .001). The Area Under the Curve (AUC) was 0.603. No calibration problems were found, the Hosmer-Lemeshow Goodness-of-fit test was not significant (p = 0.19).
Table 2

Multivariable analysis by logistic regression modelling the probability of female participation according to APA session.

VariableOdds RatioLower 95CI%Upper 95CI%P-value
Year 2019 (ref = 2009) 1.58 1,351 1,85 < .001
Role 0.01
 Presenter1 (reference)
 Chair1.0190.8781.182
 Director1.0170.2824.003
 Discussant0.8390.5571.251
 Faculty2.1770.6418.153
Session 0.006
 Symposium1 (reference)
 Courses0.4460.1171.546
 Master courses0.2880.0631.173
 Presidential session0.8640.6481.147
 Special session0.7750.3601.597
 Workshop 1.447 1.163 1.799
Topic < .001
 Child and Adolescent Psychiatry1 (reference)
 Addiction Psychiatry 0.486 0.334 0.706
 Consultation-Liaison Psychiatry 0.613 0.412 0.908
 Diversity and Health Disparity0.8880.6361.237
 Forensic Psychiatry 0.499 0.344 0.720
 Geriatric Psychiatry0.7530.4281.319
 Other topics 0.589 0.442 0.783
 Residents, Fellows, and Medical Students0.9670.6841.365

Area Under the Curve (AUC): 0.603. Hosmer-Lemeshow Goodness-of-fit test: 0.19.

Area Under the Curve (AUC): 0.603. Hosmer-Lemeshow Goodness-of-fit test: 0.19.

Discussion

Overall, WIP were more represented in the 2019 APA conference, and the multivariable analysis showed that this increase was independent from the differences in the repartition of topics, roles, or type of sessions observed in 2009 and 2019. We also collected demographic data concerning the American psychiatry workforce. Among the total number of speakers, 45% were women in 2019 versus 37% in 2009, reflecting an increase in the representation of women at the APA annual meeting over the past ten years. The representation of female speakers was higher in almost all the different types of sessions, roles and topics. The representation of female chairs increased, which could suggest that women are taking more leadership positions at the meetings now than ten years ago. Finally, female presenters were more represented in 2019. Presenters constituted the largest category among the different roles. This underlines the fact that women were more present in 2019 than in 2009. Women were significantly more present in diversity and health disparity sessions in 2019. Consequently, they constituted the majority of speakers in these sessions in 2019. Indeed, WIP seem to be more interested in disparity matters as they may feel more directly concerned. Interestingly, the proportion of female speakers increased significantly in forensic psychiatry. In contrast, female representation in child and adolescent psychiatry decreased, even if slightly. At the same time, female representation in the child and adolescent psychiatry workforce rose in the US (2010–2019). These data also show that women appeared to be overrepresented in child and adolescent psychiatry at the 2009 APA meeting. Nevertheless, the representation of women in addiction psychiatry decreased between 2009 and 2019. The results showed that female representation at the APA meetings has increased over the past decade. Simultaneously, female representation in honorific sessions did not increase. Indeed, in presidential and special sessions, female representation remained stable between 2009 and 2019. Female representation in master courses fell dramatically during this decade. However, these results can be adjusted by the low number of speakers in these categories. Nevertheless, the representation of women in honorific sessions seems to reflect the lower representation of women in academic medicine.

Literature review

To our knowledge, this is the first study to precisely evaluate the proportion of women among APA annual meeting speakers. The same work has been conducted for other specialties. Sleeman et al. [13] showed that more women were speaking at palliative care conferences. This was concordant with the fact that the palliative care workforce counted more women than men. Nevertheless, they also found that fewer women were invited as plenary speakers, one of the most honorific roles [13]. In surgery conferences, sex equity seems harder to achieve, as some sessions include an “all-male panel” [11], and changes in representation of women among speakers over time appear quite low [19]. These facts should be considered carefully as women are less present in the surgery workforce compared to the medical workforce [11, 19]. At critical care conferences, female speakers are underrepresented when compared to the percentage of women in the critical care workforce [14]. In emergency medicine, Carley et al. [8] showed that women speak less frequently and give shorter speeches than men during meetings. In Hip and Knee Surgery meetings, Cohen-Rosenblum et al. showed no evolution of women representation between 2012 and 2019 [16]. In contrast with our work, Pierron et al. [20] found an underrepresentation of female speakers during the French psychiatry meetings (2009–2018) despite a slow growth. Like in our paper, women were also more highly represented in child and adolescent psychiatry sessions. They underlined a low representation of women in chairs, similar to our result on the lower representation of women in APA honorific roles such as special presenter and director [20]. In Australia, sex equity was achieved at the Victorian Branch Conference one year after the program committee became aware of the gender gap [21]. These differences in evolution and representation observed between the American, French and Australian psychiatry meetings could be explained by the cultural particularities of each country. Arora et al. also showed a difference between regions (US, Canada, Australia, UK and Europe) considering women representation in meetings [15]. Overall, each program committee policy could also play a major part in sex disparity among speakers.

Hypothesis

This work shows the positive change in the representation of women speakers at the APA annual meetings between 2009 and 2019. One hypothesis to explain this favorable evolution is the APA’s policy on disparity and diversity. First, the APA is one of the few medical societies respecting sex disparity in the choice of their presidents [25]. This could have impacted the selection of their speakers at the annual meetings. Second, the APA 2009 and 2019 program committees consisted of 50% women and 50% men. Sex parity in the committee program could promote sex parity in the choice of speakers [26]. The APA is also an active partner organizer of the Women’s Wellness Through Equity and Leadership (WEL) Program, that promotes female career development. These positive results can be explained by the APA’s political will and commitment to the fight against discrimination. Although the APA promotes sex parity, part of the APA annual meetings did not respect sex equity in the choice of speakers. Women were underrepresented in master courses but also in honorific roles. One hypothesis to explain this underrepresentation could be that fewer women were invited to hold these positions. This might be due to a reduced visibility of women in the academic field stemming from lower opportunity to present their work as invited speakers. A study evaluating the gender disparity in the authorship of the Canadian Cardiovascular Society (CCS) guidelines over two decades showed no change in women authors percentage [27]. Similarly, Rai et al. evaluated the inclusion of women in the American College of Cardiology/American Heart Association guideline writing committees overs 15 years. They showed a persistent gender disparity over the years even though the percentage of women increased. In both studies [28], the authors concluded that further efforts are required to include more women in leaderships roles. Breaking that circle might increase female visibility in academic medicine and make them more likely to be invited as speakers [29]. Another explanation might be that, while WIP made up to 42% of the psychiatry workforce in 2019, they are still underrepresented in academic medicine. Indeed, only 22% of the department chairs in psychiatry were women in 2018 [5]. The lack of WIP in leadership positions might be a reflection of what is called the glass ceiling, which represents the invisible and artificial barriers that stop women from gaining access to senior leadership roles, despite their high representation in the field [30, 31]. Another reason could come from WIP themselves. Indeed, in evolutionary biology symposia, women were found to turn down invitations more than men. Explanations could be low self-promotion (less desire to put themselves forward), more obstacles related to managing children, a greater reluctance to speak in public or lower perception of their ability and success [29].

Strengths and limitations

This is the first time that sex disparity has been assessed in a major international psychiatric meeting as large as the APA meetings. As the APA meeting gathers a large number of speakers, the results obtained possess a high statistical power. This high statistical power allowed us to interpret the results observed. One of the strengths of our study is that it did not just assess changes in the proportion of female speakers at the APA meeting. Our work took into consideration the type of sessions, the type of roles and the topics in which the speaker was participating. This analysis allowed us to pinpoint the specific areas where representation of women increased whereas some others still need improvement. Another strength is that it did not use an automatic tool to identify the sex of each speaker. Indeed, a systematic google search of the name of the speaker was performed. In addition, sex identification was performed by two authors independently. Therefore, the risk of wrong sex assignment was quite low. There are, however, a few limitations in this study. First, the APA annual meeting brings together speakers from the US and other countries. Consequently, a good part of the speakers at the APA annual meeting were probably not American. The demographics collected for comparison, however, included only the US workforce. This is due to the lack of international data on the percentage of female psychiatrists. Another limitation is that some of the speakers were not psychiatrists. Speakers could be physicians from other specialties, but also residents, psychologists, researchers, philosophers, or lawyers. This makes the comparison to the psychiatrist workforce less pertinent. Nevertheless, psychiatrists constituted the majority of speakers, lessening the significance of this bias. Another limitation is that the data were obtained from the annual meeting programs. They did not take into account last-minute changes or cancellations. This could have led to incorrect data collection. Still, changes in programs do not happen frequently and represent only a small part of the program. Consequently, the corresponding bias can be considered minor. Another source of bias in our analysis could have come from the method used to homogenize the difference in categories. Indeed, the 2009 and 2019 programs differed in their design, but also in the semantics used. As a result, categories that existed in 2009 disappeared in 2019 and new categories appeared in 2019. To make the comparison possible between the programs, we opted to combine categories according to the definitions proposed in each program. Some definitions, however, did not match precisely and not all the terms were defined. Consequently, category mismatching could have occurred. This concern is reduced by the fact that ambiguous terminology gathered only small numbers. A final shortcoming is that it did not evaluate sex disparity for each session according to the sex of the chair. Indeed, Isbell et al. [32] showed that female chairs respect more sex disparity in the choice of speakers than male chairs. This evaluation of the impact of the sex of the chair on the choice of speaker at the APA annual meetings could be performed in a future study.

Conclusion

This study showed a positive change in female speaker representation at the APA meetings between 2009 and 2019. It also allowed us to highlight the specific roles, topics and sessions at the meetings where women are still lacking. Highlighting underrepresentation could improve the sex disparity for subsequent meetings [6]. Our results demonstrated that women were more represented at the APA meetings, when compared to the US psychiatry workforce. Even though women make up less than 50% of psychiatrists in the US, it seems important to have a high female representation at the meetings. First, speaking at a meeting increases female visibility and help younger physicians to find a woman role model in academic psychiatry. Second, the rate of female psychiatrists will probably grow quickly in upcoming years, as around 50% of the residents in psychiatry were women in 2020. We formulated a few hypotheses that could explain this favorable evolution. Additionally, recommendations are now available to help the program committee improve sex disparity at their meetings. Martin [33] listed ten rules to achieve sex equity among speakers at conferences. Interestingly, the first rule is collecting data and the fifth one reporting them, as was the purpose of this paper. Schroeder et al. listed some advice to promote gender equity in meetings, including making gender disaggregated data available [34].

Comparison of the proportions of male and female speakers in different session types at the APA 2009 and 2019 annual meetings.

(DOCX) Click here for additional data file.

Comparison of the proportion of men and women by role at the APA 2009 and 2019 APA annual meetings.

(DOCX) Click here for additional data file.

Comparison of the proportion of men and women among speakers by topic at the 2009 and 2019 APA annual meetings.

(DOCX) Click here for additional data file. (XLSX) Click here for additional data file. 22 Apr 2021 PONE-D-20-40415 Changes in sex equity at American Psychiatric Association annual meetings over 10 years (between 2009 and 2019) PLOS ONE Dear Dr. Wissam El-Hage, Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process. We do need to highlight whether there is an existent sex disparity or not. Hence, this I think that topic is relevant in terms of academia. However, the topic does not represent the paper well.  I would not use the word 'equity' here. The introduction could have more updated references relating to sex differences in academia. There are several recent papers published on this topic. The methodology is weak. 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Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: Yes Reviewer #2: No ********** 3. Have the authors made all data underlying the findings in their manuscript fully available? The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified. Reviewer #1: Yes Reviewer #2: Yes ********** 4. Is the manuscript presented in an intelligible fashion and written in standard English? PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here. Reviewer #1: Yes Reviewer #2: Yes ********** 5. Review Comments to the Author Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters) Reviewer #1: This study addressed an interesting and nice topic, and especially for the first time in psychiatry. It was appropriately planned and analyzed as well as was written in a well-fashioned manner. The aim of the study, methodology, and conclusions were perfectly synchronized. Minor suggestion: The authors mentioned, “National demographic data were obtained from the website of the Association of American Medical Colleges for 2007 and 2017 as data for 2009 and 2019 were not available”. It represents that, these were the latest data, that is data for 2008 and 2018 were also not available. I would like to suggest adding this to the statement. Reviewer #2: Comments 1. Is the title is a current public health issue? NO 2. Is the objective is clear and measurable? NO 3. Is the method clear and explained well? NO 3.1. Who is your study population? 3.2. What is your study design? 3.3. What is sampling technique? 3.4. What is sample size? 3.5. What about exclusion and inclusion criteria? 3.6. What is dependent variable? 4. Is your data is primarily or secondary? If primarily, how you collect through ten years? Or if secondary data, explain it also. 5. The recommendation needs major revision. Based on specific, measurable, time bound and reasonable. ********** 6. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files. If you choose “no”, your identity will remain anonymous but your review may still be made public. Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy. Reviewer #1: Yes: Panchanan Acharjee Reviewer #2: No [NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.] While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org. Please note that Supporting Information files do not need this step. 5 May 2021 We do need to highlight whether there is an existent sex disparity or not. Hence, this I think that topic is relevant in terms of academia. • Response: Thank you for the useful comments to enhance the quality of the paper. However, the topic does not represent the paper well. I would not use the word 'equity' here. • Response: We understand that sex disparity is a relevant topic. As suggested by the reviewer, we changed the word ‘equity’ in the text, and we replaced it in most cases by the word ‘disparity’. We also changed the title of the manuscript as follows: “Representation of women at American Psychiatric Association annual meetings over 10 years (between 2009 and 2019).” Indeed, this title is consistent with the primary objective of our work that was to evaluate the evolution of female speakers representation at APA annual meetings over ten years. In our paper, we highlighted an overall increase of female speakers in 2019 compared to 2009. We also showed that women were still underrepresented in leadership roles and honorific sessions in 2019. We also changed the wording where appropriate in the manuscript, replacing the word ‘equity’ in most cases by the word ‘disparity’. The introduction could have more updated references relating to sex differences in academia. There are several recent papers published on this topic. • Response: As suggested, we updated our references. We added more recent references in the Introduction and Discussion sections as suggested. We added the following references: 15. Arora A, Kaur Y, Dossa F, Nisenbaum R, Little D, Baxter NN. Proportion of Female Speakers at Academic Medical Conferences Across Multiple Specialties and Regions. JAMA 2020;3(9):e2018127. 16. Cohen-Rosenblum AR, Bernstein JA, Cipriano CA. Gender Representation in Speaking Roles at the American Association of Hip and Knee Surgeons Annual Meeting: 2012-2019. The Journal of Arthroplasty. 2021;S0883540321000383. 17. Harris KT, Clifton MM, Matlaga BR, Koo K. Gender Representation Among Plenary Panel Speakers at the American Urological Association Annual Meeting. Urology. 2021;150:54‑8. 32. Schroeder E, Rochford C, Voss M, Gabrysch S. Beyond representation: women at global health conferences. The Lancet. 2019;393:1200‑1. The methodology is weak. The authors should use hierarchical regression technique in their statistical analysis. That would give more insight into the results once partial pooling is used. At present, frequencies and chi square analysis have been applied in the analysis. This analysis does not do justice to the objective of the paper. The discussion could be made stronger by using updated references. • Response: We followed your recommendations. As requested, we performed new analyses. We added the following to the Statistics section: “We performed a multivariable analysis by logistic regression, evaluating the probability of female participation according to role, type of session, topic and APA year (2019 vs 2009). The descriptive analysis was conducted with SPSS (IBM, Inc., Armonk, NY). The multivariable analysis was conducted using R version 4.0.2 (www.R-project.org). All the tests used were two-tailed. Statistical significance was defined as p-value<0.05.” We added the following to the Results section: “Results of the multivariable analysis are presented in Table 2. The probability of female participation increased between 2009 and 2019, with an Odds Ratio of 1.580 (95%CI 1.351-1.850, p<.001). The Area Under the Curve (AUC) was 0.603. No calibration problems were found, the Hosmer-Lemeshow Goodness-of-fit test was not significant (p=0.19).” We added the Table 2: Multivariable analysis by logistic regression modelling the probability of female participation according to APA session. 1. Please ensure that your manuscript meets PLOS ONE's style requirements, including those for file naming. The PLOS ONE style templates can be found at https://journals.plos.org/plosone/s/file?id=wjVg/PLOSOne_formatting_sample_main_body.pdf and https://journals.plos.org/plosone/s/file?id=ba62/PLOSOne_formatting_sample_title_authors_affiliations.pdf • Response: We made the appropriate changes according to the guidelines. 2. Please improve statistical reporting and refer to p-values as "p<.001" instead of "p<.0001". Our statistical reporting guidelines are available at https://journals.plos.org/plosone/s/submission-guidelines#loc-statistical-reporting • Response: We made the appropriate changes in statistical reporting as required. 3. Please include your tables as part of your main manuscript and remove the individual files. Please note that supplementary tables (should remain/ be uploaded) as separate "supporting information" files • Response: As requested, we included the Tables in the main manuscript. We also added “supporting information” files as required. 4. Thank you for stating the following in the Competing Interests section: CH reports personal fees from EISAI, Janssen, Lundbeck, Otsuka and UCB. WEH reports personal fees from EISAI, Janssen, Lundbeck, Otsuka, UCB, Roche and Chugai. Please confirm that this does not alter your adherence to all PLOS ONE policies on sharing data and materials, by including the following statement: "This does not alter our adherence to PLOS ONE policies on sharing data and materials.” (as detailed online in our guide for authors http://journals.plos.org/plosone/s/competing-interests). If there are restrictions on sharing of data and/or materials, please state these. Please note that we cannot proceed with consideration of your article until this information has been declared. Please include your updated Competing Interests statement in your cover letter; we will change the online submission form on your behalf. Please know it is PLOS ONE policy for corresponding authors to declare, on behalf of all authors, all potential competing interests for the purposes of transparency. PLOS defines a competing interest as anything that interferes with, or could reasonably be perceived as interfering with, the full and objective presentation, peer review, editorial decision-making, or publication of research or non-research articles submitted to one of the journals. Competing interests can be financial or non-financial, professional, or personal. Competing interests can arise in relationship to an organization or another person. Please follow this link to our website for more details on competing interests: http://journals.plos.org/plosone/s/competing-interests • Response: As requested, we added a Competing Interests section reporting the following: “CH reports personal fees from EISAI, Janssen, Lundbeck, Otsuka and UCB. WEH reports personal fees from Air Liquide, EISAI, Janssen, Lundbeck, Otsuka, UCB, Roche and Chugai. This does not alter our adherence to PLOS ONE policies on sharing data and materials.” We confirm that the reported competing interests do not alter our adherence to PLOS ONE policies on sharing data and materials. We also removed the competing interests section from the our manuscript. We included our updated Competing Interests statement in your cover letter. 5. Please amend your list of authors on the manuscript to ensure that each author is linked to an affiliation. Authors’ affiliations should reflect the institution where the work was done (if authors moved subsequently, you can also list the new affiliation stating “current affiliation:….” as necessary). • Response: We made the appropriate changes as required. 6. Please ensure that you refer to Figure 1-2 in your text as, if accepted, production will need this reference to link the reader to the Figure. • Response: We added the references for the Figures in the text. We also changed the way we presented the Figures in line with PLOS ONE's style requirements. 7. Please include captions for your Supporting Information files at the end of your manuscript, and update any in-text citations to match accordingly. Please see our Supporting Information guidelines for more information: http://journals.plos.org/plosone/s/supporting-information. • Response: We added captions for supporting information files at the end of the manuscript. We also added a separate file. Review Comments to the Author Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters). Reviewer #1: This study addressed an interesting and nice topic, and especially for the first time in psychiatry. It was appropriately planned and analyzed as well as was written in a well-fashioned manner. The aim of the study, methodology, and conclusions were perfectly synchronized. Minor suggestion: The authors mentioned, “National demographic data were obtained from the website of the Association of American Medical Colleges for 2007 and 2017 as data for 2009 and 2019 were not available”. It represents that, these were the latest data, that is data for 2008 and 2018 were also not available. I would like to suggest adding this to the statement. • Response: Many thanks for the proposition. As proposed, we added the following sentence in the manuscript: “Data for 2008 and 2018 were also not available.” Reviewer #2: Comments 1. Is the title is a current public health issue? NO • Response: Our work addressed the evolution of the representation of women in the most attended annual psychiatry meeting. It also questioned women actual place in academic psychiatry in general. Thus, this work is indeed not at public health issue but , we believe, an important society issue. Hence, we think that topic is relevant in terms of academia. 2. Is the objective is clear and measurable? NO • The goal of this work was to explore the evolution of women representation among speakers of the APA annual meetings over 10 years. To measure the evolution of women speakers, we analyzed the evolution of the proportion of women speakers at the APA annual meeting in 2009 and 2019. In order to explore this evolution, we compared the sex distribution of the speakers at the APA meeting in 2019 to the sex distribution of the speakers at the APA meeting in 2019. A variation of the sex distribution was highlighted with a p value< 0.05. 3. Is the method clear and explained well? NO • Response: We used the programs of the 2009 and 2019 APA annual meetings to extract the data. Variables collected for each speaker were: sex, role during their intervention, type of the session they took part in and topic of the session. 3.1. Who is your study population? • Response: Our study population consisted of the speakers at the 2009 and 2019 APA annual meetings. 3.2. What is your study design? • Response: Our study was designed using a retrospective, cross-sectional methodology. We added that in our manuscript. 3.3. What is sampling technique? • Response: No sampling was performed. We collected the data for all the speakers of the 2009 and 2019 APA annual meetings. 3.4. What is sample size? • Response: Our study population was of 1093 and 1762 speakers at the 2009 and 2019 APA meetings respectively. We mentioned it in the results. 3.5. What about exclusion and inclusion criteria? • Response: Speakers at the APA 2009 or/and 2019 meeting were included in this work. Speakers who participated only in poster presentations were excluded. Sessions which did not exist in 2009 and 2019 were not taken into consideration as well as the speakers who took part in it. 3.6. What is dependent variable? • Response: Not relevant here. 4. Is your data is primarily or secondary? If primarily, how you collect through ten years? Or if secondary data, explain it also. • Response: We did not collect data through ten years. We collected the data of 2009 and 2019 APA annual meeting programs. In the programs, the sex of the speakers was not mentioned. We identified the sex of the speakers using the speaker’s name mentioned in the program combined with an internet search. From the meetings programs, we then extracted the type of sessions in which the speaker presented, the speaker’s role in the session and the topic of the session. All these data were compiled in an excel file. To avoid any mistake, the data was reviewed by two of the authors. 5. The recommendation needs major revision. Based on specific, measurable, time bound and reasonable. • Response: Thank you for the useful comments to enhance the quality of the paper. Submitted filename: Reponse to Reviewers.docx Click here for additional data file. 21 Sep 2021
PONE-D-20-40415R1
Representation of women at American Psychiatric Association annual meetings over 10 years (between 2009 and 2019)
PLOS ONE Dear Dr. El-Hage, Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process. Please submit your revised manuscript by Nov 05 2021 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file. Please include the following items when submitting your revised manuscript:
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Reviewer #1: All comments have been addressed Reviewer #3: (No Response) Reviewer #4: (No Response) ********** 2. Is the manuscript technically sound, and do the data support the conclusions? The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented. Reviewer #1: Partly Reviewer #3: No Reviewer #4: Yes ********** 3. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: I Don't Know Reviewer #3: No Reviewer #4: Yes ********** 4. Have the authors made all data underlying the findings in their manuscript fully available? The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified. Reviewer #1: Yes Reviewer #3: (No Response) Reviewer #4: Yes ********** 5. Is the manuscript presented in an intelligible fashion and written in standard English? PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here. Reviewer #1: Yes Reviewer #3: No Reviewer #4: Yes ********** 6. Review Comments to the Author Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters) Reviewer #1: I had some minor revisions, all were addressed. The study can be published, on the merit of their specific presentation on the change in participation of female; if queries by other reviewers are addressed properly. Reviewer #3: Referee Report PLOS ONE, PONE-D-20-40415R1 Representation of women at American Psychiatric Association annual meetings over 10 years (between 2009 and 2019) A. Summary This paper studies the change in women’s representation in academic Psychiatry, which is an important and timely topic, by comparing the female share of women in the American Psychiatric Association annual meetings in 2009 versus 2019. B. Overall takeaway This paper finds that the percentage of female speakers was larger in 2019 than 2009, which implies that the representation of women at the APA annual meetings has increased during the period. C. Major comments 1. Statistical method and interpretation As the authors responded to reviewer #2, the population of this study is “the speakers at the 2009 and 2019 APA annual meetings,” and the data of this study are not sample data, but population data: “We collected the data for all the speakers of the 2009 and 2019 APA annual meetings.” Here, the parameters of interest are the percentages of women of all the speakers in the meetings, which can be found by simply calculating the percentage using the population data the authors have. In other words, the parameters of interest are known, so it is inappropriate to perform any statistical estimation (i.e. z-test, Chi2 analysis, p-value, etc.), which is the process to use sample estimates to approximate the value of unknown population parameters. See similar previous papers (e.g. Gerull et al. 2020, Sleeman et al. 2019, and May and Dimand 2019) which simply report the number/percentage of women without any tests and perform statistical tests only when they need to estimate some unknown parameters. In the result section, the authors repetitively report estimates, p-values, and statistical significance of the estimates. For the reasons I mentioned above, however, I am neither persuaded that these statistical analyses in this study are well performed, nor that the interpretation and discussion of the results are presented in an appropriate/intelligible fashion. 2. Logistic regression The authors mechanically report the result of the logistic regression without any interpretation. I cannot find any consideration as to why the explanatory variables are chosen or what the estimates mean. The authors added this analysis responding to a previous reviewer who suggested to use a hierarchical regression technique, but the logistic regression was not performed as such. 3. Suggestion This paper would be more substantial if the authors went beyond the current research question: whether the percentage of women in the APA meetings increased between 2009 and 2019. The question would be easily answered by simply calculating the percentage of women in the data without any statistical inferences. A possible question which can be further studied with the data is which factor explains the increase in the women’s representation (this is the question where statistical estimation is really needed). Although the authors suggest some possible explanations in the discussion section, they are weakly supported by the data. For example, an interesting question left for future research is “the impact of the sex of the chair on the choice of speaker at the APA annual meetings,” as suggested by the authors in “Strengths and limitations.” If the data provide the information on chairs of each APA meeting session, the authors would be able to regress the percentage of women in a session on the gender of the chair of the session controlling for other explanatory variables. D. Minor comments 1. Consistency with the national demographic data The authors could provide more empirical analyses, especially in terms of the limitations of this paper mentioned in the subsection “Strengths and limitations.” For example, one of the limits is that the speakers of the APA meetings are not necessarily U.S. researchers; they also consist of researchers from other countries. The authors could reduce this concern by collecting data on the speakers’ institutions (as the authors collected the gender of the speakers) to determine whether the speakers working within or without the U.S. 2. Referring to figures Although a previous reviewer suggested to “ensure that you refer to Figure 1-2 in your text,” such figures have not been explicitly referred to by the text. The authors could mention figures 1-3 somewhere in the subsections “Roles,” “Topics,” or “Sessions” of the Results section. E. Citations Katherine M. Gerull, Brandon Malik Wahba, Laurel M. Goldin, Jared McAllister, Andrew Wright, Amalia Cochran, Arghavan Salles. Representation of women in speaking roles at surgical conferences. The American Journal of Surgery. 2020;220(1):20-26. Katherine E. Sleeman, Jonathan Koffman, Irene J. Higginson. Leaky pipeline, gender bias, self-selection or all three? A quantitative analysis of gender balance at an international palliative care research conference. BMJ Supportive & Palliative Care. 2019;9:146-148. Ann Mari May, Robert W. Dimand. Women in the Early Years of the American Economic Association: A Membership beyond the Professoriate Per Se. History of Political Economy. 2019;51(4):671–702. Reviewer #4: I applaud the effort of the authors to study the trends and gender differences in APA conferences over the years. The inclusion of women at conferences is similar to that of workforce. However, still there is no parity in the workforce which is likely impact of slower growth. Abstract: It will be advisable to add how sex was determined in the study in methods. Introduction: Well written. There are new acronyms being used such as WIM, WIC. It will be good to use WIP: women in psychiatry as a new acronym and use it throughout the manuscript. APA is not defined and used directly. Methods: The design is intuitive. However, would need to clarify and improve a few things. How and who made the decision regarding adding unmentioned 2009 topics to enter into a different group in 2019. As mentioned some authors were included in multiple sessions, how about comparing the repetition of male vs female authors. As in the past similar studies, women have fewer repetition compared to men. https://www.acgme.org/About-Us/Publications-and-Resources/Graduate-Medical-Education-Data-Resource-Book/ Results: The above website provided updated data up to 2019 for women pshyciatry fellows, those could be mentioned rather than 2007 and 2017. “Compared to 2009, the proportion of female chairs increased by 12% in 2019, though not significantly (42% vs 47%; p=0.70).” There seems to be an increase of 5%. Also, it will be good to give absolute number first and then percentages in brackets to show the numerical increase as well and in compliance with scientific documentation. It will be also good for the results section to be direct rather than negating it. Eg.: “Compared to 2009, the proportion of female chairs increased by 12% in 2019, though not significantly (42% vs 47%; p=0.70). Can be modified to The proportion of female chairs remained similar from xxx(42%) in 2009 to yyy(47%) in 2020. Or There was no significant trend in …. This can be implied throughput and the word count will decrease. Eg: The percentage of female speakers in addiction psychiatry decreased dropped by 21%, Remove either one of the bolded as they are synonymous Discussion: Starts with again mentioning about methods and rationale which can be cut short for the first paragraph by removing first 2 lines. The discussion seems to be very well written and compared with all specialties. It will be also good to compare with cardiology and women leadership as well in the discussions section and consider citing the following paper. https://www.ahajournals.org/doi/full/10.1161/CIRCOUTCOMES.120.007578 https://www.sciencedirect.com/science/article/pii/S2589790X21000986 https://www.ahajournals.org/doi/full/10.1161/CIRCULATIONAHA.119.044693 ********** 7. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files. If you choose “no”, your identity will remain anonymous but your review may still be made public. Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy. Reviewer #1: No Reviewer #3: No Reviewer #4: No [NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.] While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org. Please note that Supporting Information files do not need this step. Submitted filename: Referee Report PLOS ONE.pdf Click here for additional data file. 1 Nov 2021 Reviewers' comments: Reviewer's Responses to Questions Comments to the Author 1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation. Reviewer #1: All comments have been addressed Reviewer #3: (No Response) Reviewer #4: (No Response) 2. Is the manuscript technically sound, and do the data support the conclusions? The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented. Reviewer #1: Partly Reviewer #3: No Reviewer #4: Yes 3. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: I Don't Know Reviewer #3: No Reviewer #4: Yes 4. Have the authors made all data underlying the findings in their manuscript fully available? The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified. Reviewer #1: Yes Reviewer #3: (No Response) Reviewer #4: Yes 5. Is the manuscript presented in an intelligible fashion and written in standard English? PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here. Reviewer #1: Yes Reviewer #3: No Reviewer #4: Yes 6. Review Comments to the Author Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters) Reviewer #1: I had some minor revisions, all were addressed. The study can be published, on the merit of their specific presentation on the change in participation of female; if queries by other reviewers are addressed properly. - Response: We are grateful to Reviewer #1 for the comments that helped us improving the manuscript. --- Reviewer #3: Referee Report PLOS ONE, PONE-D-20-40415R1 Representation of women at American Psychiatric Association annual meetings over 10 years (between 2009 and 2019) A. Summary This paper studies the change in women’s representation in academic Psychiatry, which is an important and timely topic, by comparing the female share of women in the American Psychiatric Association annual meetings in 2009 versus 2019. B. Overall takeaway This paper finds that the percentage of female speakers was larger in 2019 than 2009, which implies that the representation of women at the APA annual meetings has increased during the period. C. Major comments 1. Statistical method and interpretation As the authors responded to reviewer #2, the population of this study is “the speakers at the 2009 and 2019 APA annual meetings,” and the data of this study are not sample data, but population data: “We collected the data for all the speakers of the 2009 and 2019 APA annual meetings.” Here, the parameters of interest are the percentages of women of all the speakers in the meetings, which can be found by simply calculating the percentage using the population data the authors have. In other words, the parameters of interest are known, so it is inappropriate to perform any statistical estimation (i.e. z-test, Chi2 analysis, p-value, etc.), which is the process to use sample estimates to approximate the value of unknown population parameters. See similar previous papers (e.g. Gerull et al. 2020, Sleeman et al. 2019, and May and Dimand 2019) which simply report the number/percentage of women without any tests and perform statistical tests only when they need to estimate some unknown parameters. In the result section, the authors repetitively report estimates, p-values, and statistical significance of the estimates. For the reasons I mentioned above, however, I am neither persuaded that these statistical analyses in this study are well performed, nor that the interpretation and discussion of the results are presented in an appropriate/intelligible fashion. - Response: As suggested, we removed the estimates of statistical significance. Descriptive statistics were recalculated. We changed the presentation of our Results section in order to make it easier to read. 2. Logistic regression The authors mechanically report the result of the logistic regression without any interpretation. I cannot find any consideration as to why the explanatory variables are chosen or what the estimates mean. The authors added this analysis responding to a previous reviewer who suggested to use a hierarchical regression technique, but the logistic regression was not performed as such. - Response: We added an explanation of the choice of variables included in the model. “The variables to be included in the logistic regression model were selected to reflect the main differences in congress structure between 2009 and 2019.” We provided an explanation of the information added by the regression model in the Discussion. “Overall, women were more represented in the 2019 APA conference, and the multivariable analysis shows that this increase was independent of the differences in the repartition of topics, roles, or type of sessions observed in 2009 and 2019.” We performed a simple (non-hierarchical) logistic regression model because the structure of the data available to us was not well suited for multilevel modelling. This is because although we could ascertain the topic of a presentation for any participant, in our final database we cannot distinguish which participants attended the same presentation together (there was no unique session ID in the final database). Therefore, we cannot cluster participants by individual presentations. 3. Suggestion This paper would be more substantial if the authors went beyond the current research question: whether the percentage of women in the APA meetings increased between 2009 and 2019. The question would be easily answered by simply calculating the percentage of women in the data without any statistical inferences. A possible question which can be further studied with the data is which factor explains the increase in the women’s representation (this is the question where statistical estimation is really needed). - Response: The topics of the sessions attended are available in our data, however the names of the sessions themselves have been removed. Therefore, as there can be multiple sessions with the same topic on the same day, we cannot link individual participants with the chair of their session. Although the authors suggest some possible explanations in the discussion section, they are weakly supported by the data. - Response: We removed some parts of the Discussion that were not directly linked to our results. For example, an interesting question left for future research is “the impact of the sex of the chair on the choice of speaker at the APA annual meetings,” as suggested by the authors in “Strengths and limitations.” If the data provide the information on chairs of each APA meeting session, the authors would be able to regress the percentage of women in a session on the gender of the chair of the session controlling for other explanatory variables. - Response: As our database does not have the names of each unique session, unfortunately we are not able to conduct this analysis. D. Minor comments 1. Consistency with the national demographic data The authors could provide more empirical analyses, especially in terms of the limitations of this paper mentioned in the subsection “Strengths and limitations.” For example, one of the limits is that the speakers of the APA meetings are not necessarily U.S. researchers; they also consist of researchers from other countries. The authors could reduce this concern by collecting data on the speakers’ institutions (as the authors collected the gender of the speakers) to determine whether the speakers working within or without the U.S. - Response: Unfortunately, this information is not available in our database. 2. Referring to figures Although a previous reviewer suggested to “ensure that you refer to Figure 1-2 in your text,” such figures have not been explicitly referred to by the text. The authors could mention figures 1-3 somewhere in the subsections “Roles,” “Topics,” or “Sessions” of the Results section. - Response: We made the appropriate changes as suggested. E. Citations Katherine M. Gerull, Brandon Malik Wahba, Laurel M. Goldin, Jared McAllister, Andrew Wright, Amalia Cochran, Arghavan Salles. Representation of women in speaking roles at surgical conferences. The American Journal of Surgery. 2020;220(1):20-26. Katherine E. Sleeman, Jonathan Koffman, Irene J. Higginson. Leaky pipeline, gender bias, self-selection or all three? A quantitative analysis of gender balance at an international palliative care research conference. BMJ Supportive & Palliative Care. 2019;9:146-148. Ann Mari May, Robert W. Dimand. Women in the Early Years of the American Economic Association: A Membership beyond the Professoriate Per Se. History of Political Economy. 2019;51(4):671–702. - Response: We made the appropriate changes to the references section. --- Reviewer #4: I applaud the effort of the authors to study the trends and gender differences in APA conferences over the years. The inclusion of women at conferences is similar to that of workforce. However, still there is no parity in the workforce which is likely impact of slower growth. - Response: We thank the Reviewer #4 for these encouragements. Abstract: It will be advisable to add how sex was determined in the study in methods. - Response: We changed the Methods section to clarify this issue: “The sex of the speakers was identified using their first and last names, combined with an Internet search, which was necessary to confirm cases for which direct identification was not possible. Sex identification was performed by one author, then verified by a second one to avoid wrong sex assignment.” Introduction: Well written. - Response: Thank you for this positive comment. There are new acronyms being used such as WIM, WIC. It will be good to use WIP: women in psychiatry as a new acronym and use it throughout the manuscript. - Response: We added the acronym “WIP: women in psychiatry” and used it throughout the revised manuscript. APA is not defined and used directly. - Response: We added the definition of APA in the revised manuscript. Methods: The design is intuitive. However, would need to clarify and improve a few things. How and who made the decision regarding adding unmentioned 2009 topics to enter into a different group in 2019. - Response: We clarified this point as follows: “As some of the topics mentioned in 2009 did not match those in 2019 and were more complex, the authors decided after collegiate discussion to assign one of the 2019 topics to a part of the 2009 sessions. Sessions with no topic mentioned or no topic corresponding to the list were labeled as “other topics”.” As mentioned some authors were included in multiple sessions, how about comparing the repetition of male vs female authors. As in the past similar studies, women have fewer repetition compared to men. - Response: Concerning the repetition, we have available data mentioned in the text: “The number of interventions per speaker decreased for both genders: from 1.26 to 1.14 interventions per speaker for women and from 1.57 to 1.40 interventions per speaker for men.” However the names of the sessions themselves have been removed. Therefore, as there can be multiple sessions with the same topic on the same day, we cannot link individual participants with the chair of their session. https://www.acgme.org/About-Us/Publications-and-Resources/Graduate-Medical-Education-Data-Resource-Book/ Results: The above website provided updated data up to 2019 for women psychiatry fellows, those could be mentioned rather than 2007 and 2017. - Response: We thank the reviewer #4 for sharing this valuable resource. Accordingly, we changed the data in the text. Also, it will be good to give absolute number first and then percentages in brackets to show the numerical increase as well and in compliance with scientific documentation. - Response: We complied to this convention in the revised manuscript. It will be also good for the results section to be direct rather than negating it. E.g.: “Compared to 2009, the proportion of female chairs increased by 12% in 2019, though not significantly (42% vs 47%; p=0.70). Can be modified to: “The proportion of female chairs remained similar from xxxx (42%) in 2009 to yyyy (47%) in 2020. “ Or: “There was no significant trend in ….” This can be implied throughput and the word count will decrease. - Response: As suggested, we made the appropriate changes in the revised manuscript. E.g.: The percentage of female speakers in addiction psychiatry decreased dropped by 21%. Remove either one of the bolded as they are synonymous - Response: We made the appropriate correction in the revised manuscript. Discussion: Starts with again mentioning about methods and rationale which can be cut short for the first paragraph by removing first 2 lines. - Response: We removed these lines in the revised manuscript. The discussion seems to be very well written and compared with all specialties. - Response: We thank the reviewer #4 for this appreciation of our work. It will be also good to compare with cardiology and women leadership as well in the discussions section and consider citing the following paper. https://www.ahajournals.org/doi/full/10.1161/CIRCOUTCOMES.120.007578 https://www.sciencedirect.com/science/article/pii/S2589790X21000986 https://www.ahajournals.org/doi/full/10.1161/CIRCULATIONAHA.119.044693 - Response: We thank the reviewer for this resource and cited these papers in the revised manuscript. 24 Nov 2021 Representation of women at American Psychiatric Association annual meetings over 10 years (between 2009 and 2019) PONE-D-20-40415R2 Dear Dr. El-Hage, We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements. Within one week, you’ll receive an e-mail detailing the required amendments. When these have been addressed, you’ll receive a formal acceptance letter and your manuscript will be scheduled for publication. An invoice for payment will follow shortly after the formal acceptance. To ensure an efficient process, please log into Editorial Manager at http://www.editorialmanager.com/pone/, click the 'Update My Information' link at the top of the page, and double check that your user information is up-to-date. If you have any billing related questions, please contact our Author Billing department directly at authorbilling@plos.org. If your institution or institutions have a press office, please notify them about your upcoming paper to help maximize its impact. If they’ll be preparing press materials, please inform our press team as soon as possible -- no later than 48 hours after receiving the formal acceptance. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information, please contact onepress@plos.org. Kind regards, Marc Potenza Academic Editor PLOS ONE Additional Editor Comments (optional): Reviewers' comments: Reviewer's Responses to Questions Comments to the Author 1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation. Reviewer #4: All comments have been addressed ********** 2. Is the manuscript technically sound, and do the data support the conclusions? The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented. Reviewer #4: Yes ********** 3. Has the statistical analysis been performed appropriately and rigorously? Reviewer #4: Yes ********** 4. Have the authors made all data underlying the findings in their manuscript fully available? The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified. Reviewer #4: Yes ********** 5. Is the manuscript presented in an intelligible fashion and written in standard English? PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here. Reviewer #4: Yes ********** 6. Review Comments to the Author Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters) Reviewer #4: The authors have done a commendable job on addressing all the issues. They are addressing an important issue which is important to address in the current era. ********** 7. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files. If you choose “no”, your identity will remain anonymous but your review may still be made public. Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy. Reviewer #4: No
  28 in total

1.  Gender Representation in Speaking Roles at the American Association of Hip and Knee Surgeons Annual Meeting: 2012-2019.

Authors:  Anna R Cohen-Rosenblum; Jenna A Bernstein; Cara A Cipriano
Journal:  J Arthroplasty       Date:  2021-01-15       Impact factor: 4.757

2.  Representation of women in speaking roles at surgical conferences.

Authors:  Katherine M Gerull; Brandon Malik Wahba; Laurel M Goldin; Jared McAllister; Andrew Wright; Amalia Cochran; Arghavan Salles
Journal:  Am J Surg       Date:  2019-09-09       Impact factor: 2.565

3.  Representation of Women Among Invited Speakers at Medical Specialty Conferences.

Authors:  Allison R Larson; Katherine M Sharkey; Julie A Poorman; Carolyn K Kan; Susan M Moeschler; Rekha Chandrabose; Carol M Marquez; Daleela G Dodge; Julie K Silver; Rosalynn M Nazarian
Journal:  J Womens Health (Larchmt)       Date:  2019-11-05       Impact factor: 2.681

4.  The presence of female conveners correlates with a higher proportion of female speakers at scientific symposia.

Authors:  Arturo Casadevall; Jo Handelsman
Journal:  MBio       Date:  2014-01-07       Impact factor: 7.867

5.  Ten simple rules to achieve conference speaker gender balance.

Authors:  Jennifer L Martin
Journal:  PLoS Comput Biol       Date:  2014-11-20       Impact factor: 4.475

6.  Stag parties linger: continued gender bias in a female-rich scientific discipline.

Authors:  Lynne A Isbell; Truman P Young; Alexander H Harcourt
Journal:  PLoS One       Date:  2012-11-21       Impact factor: 3.240

7.  Fewer invited talks by women in evolutionary biology symposia.

Authors:  J Schroeder; H L Dugdale; R Radersma; M Hinsch; D M Buehler; J Saul; L Porter; A Liker; I De Cauwer; P J Johnson; A W Santure; A S Griffin; E Bolund; L Ross; T J Webb; P G D Feulner; I Winney; M Szulkin; J Komdeur; M A Versteegh; C K Hemelrijk; E I Svensson; H Edwards; M Karlsson; S A West; E L B Barrett; D S Richardson; V van den Brink; J H Wimpenny; S A Ellwood; M Rees; K D Matson; A Charmantier; N Dos Remedios; N A Schneider; C Teplitsky; W F Laurance; R K Butlin; N P C Horrocks
Journal:  J Evol Biol       Date:  2013-06-20       Impact factor: 2.411

8.  Not "Pulling up the Ladder": Women Who Organize Conference Symposia Provide Greater Opportunities for Women to Speak at Conservation Conferences.

Authors:  Stephanie Sardelis; Joshua A Drew
Journal:  PLoS One       Date:  2016-07-28       Impact factor: 3.240

9.  Proportion of Female Speakers at Academic Medical Conferences Across Multiple Specialties and Regions.

Authors:  Anuj Arora; Yuvreet Kaur; Fahima Dossa; Rosane Nisenbaum; Darby Little; Nancy N Baxter
Journal:  JAMA Netw Open       Date:  2020-09-01

10.  Assessing Contemporary Trends in Female Speakership within Urologic Oncology.

Authors:  Ruchika Talwar; Adrien Bernstein; Amanda Jones; Juanita Crook; Andrea B Apolo; Jennifer M Taylor; Lauren M Burke; Elizabeth R Plimack; Sima P Porten; Kirsten L Greene; Sarah P Psutka; Angela B Smith
Journal:  Urology       Date:  2020-08-13       Impact factor: 2.633
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