Peek at the glass ceiling: gender distribution of leadership among emergency medicine residency programs

BACKGROUND: A gender gap in faculty rank at academic institutions exists; however, data among graduate medical education (GME) programmes are limited. There is a need to assess gender disparities in GME leadership, as a lack of female leadership may affect recruitment, role modelling and mentorship of female trainees. This cross-sectional study aimed to describe the current state of gender in programme leadership (department chair, programme director (PD), associate/assistant PD (APD) and clerkship director (CD)) at accredited Emergency Medicine (EM) programmes in the USA to determine whether a gender gap exists. METHODS: A survey was distributed to EM residency programmes in the USA assessing demographics and gender distribution among programme leadership. If no response was received, information was collected via the programme's website. Data were organised by position, region and length of the programme. We obtained data on the number of female EM physicians in practice and in training/fellowship in 2017 from the Association of American Medical Colleges. Data analysis was completed using descriptive statistics and χ² analysis. RESULTS: Of the 226 programmes contacted, 148 responded to the survey (66.3%). Among US EM residency programmes, 11.2% of chairs, 34.6% of PDs, 40.5% of APDs and 46.5% of CDs are women. The percentage of female chairs is significantly lower than the percentage of women in practice or in training in EM. The percentage of female PDs did not differ from the percentage of women in practice or in training in EM. The percentage of female APDs and CDs was significantly higher than the percentage of women in practice but did not differ from the percentage in training. There was wide variability across regions. Four-year programmes had more women in PD and APD positions compared with 3-year programmes (p=0.01). CONCLUSIONS: While the representation of women in educational roles is encouraging, the number of women holding the rank of chairperson remains disproportionately low. Further studies are needed to evaluate reasons for this and strategies to increase gender equality in leadership roles.