Trend of Representation of Women in Gastroenterology, Hepatology, and Endoscopy Conferences in Asia

Abstract

ABSTRACT

Objectives

Despite progress in promoting gender equality, gender bias remains a significant obstacle for women and hinders their academic advancement. We aim to survey and critically analyze women's representation in conferences and changes over time in various regions of Asian countries.

Methods

An international survey was conducted with representatives from East Asia (Hong Kong, China, and Japan), South Asia (India and Pakistan), and Southeast Asia (Vietnam and Thailand). The survey collected data on faculty members serving as chairpersons, moderators, speakers, and organizing committee members of annual scientific meetings held between 2018 and 2022.

Results

A total of 33 conferences were held between 2018 and 2022: 24 in gastroenterology, 5 in hepatology, and 4 in endoscopy across East, South, and Southeast Asia, respectively. The total number of invited faculty members was 4106. Out of 4106, the number of women involved as chairperson, moderator, speakers, and organizing committee was 105, 78, 290, and 146, respectively. The representation of women faculty ranged from 3.8% to 25% in East Asia, 9.2% to 13.5% in South Asia, and 11.8% to 34.3% in Southeast Asia. Overall, the increase in women's participation was minor and statistically non‐significant. However, there was an increase of women's participation as chairpersons, moderators, speakers, and organizing committee members from 14.1% in 2018 to 15.2% in 2022.

Conclusion

Participation of women in Asian annual conferences in the capacity of chairperson, moderator, speaker, and/or organizing committee member was significantly under‐represented. This under‐representation necessitates targeted measures to enhance women's roles in these meetings, thereby supporting their career advancement.

Introduction

Despite some progress in promoting gender equality, gender bias remains a significant obstacle for women in the workplace, hindering their academic advancement and perpetuating gender disparity [1–3]. Historically, the gastroenterology field has been dominated by men; however, now the trend is shifting, and more women join the field. In the USA, 25%–30% of GI fellows are women [4]. Women face numerous hurdles on their path, not just to becoming gastroenterologists but also to demonstrating their competence in any field of medicine and beyond. These factors include an inflexible training schedule, a “maternal wall” (being a primary caregiver), a lack of female role models, and difficulty in finding same-gender mentorship. The persistent pay gap and sexual harassment also pose significant challenges, which all lead to difficulties in career advancement and job satisfaction [5–9]. Carr et al. found that across career trajectories, gender disparities in rank, retention, and leadership exist among faculty. Compared with male colleagues, women suffered more and were less likely to attain senior positions, even after adjusting for productivity levels related to publications [10, 11].

In addition to the workplace, women also face invisible obstacles, hindering their growth in physician-supported specialty societies, and this lack of acknowledgment for their accomplishments has led to fewer leadership roles across many specialties [12–14]. The leadership role could be reflected in the academic annual conferences, which are usually held to promote learning, networking, sharing the latest advancement in the field, and providing a platform as a speaker that helps to achieve national recognition. Similarly, being chosen as a moderator or panelist increases an individual's exposure to the academic community, confers expertise to the participant, and contributes to academic promotions [15].

Although women have made significant contributions in the field of gastroenterology, they are still underrepresented at every step [16]. Regrettably, there is a dearth of literature that delves into the matter and even fewer works that offer suggestions for improvement. The focus of our research was to survey and critically observe the representation of women in gastroenterology, hepatology, and endoscopy conferences in East, South, and Southeast Asian countries. This study is the first of its kind to analyze the gender-based differences among chairpersons, moderators, speakers, and organizing committee (OC) members at the annual conferences of gastroenterology, hepatology, and endoscopy in different countries of Asia. We also explore their relationship with gender dynamics of society and conference leadership and identify the trends over time.

Methods

This was a multinational, retrospective survey of the gender-based difference in the contribution and participation in one of the most representative regional gastroenterology, hepatology, and endoscopy meetings. We sent the request for participation in nine countries across West, East, South, and Southeast Asia. There were six responses from six countries in East Asia (Hong Kong, China, and Japan), South Asia (India and Pakistan), and Southeast Asia (Vietnam and Thailand) (Figure 1). The number of faculty members (moderators, chairpersons), speakers, and OC of the corresponding annual meetings from 2018 to 2022 were recorded (Table 1). The percentage of female members in each of these roles was calculated and compared over time. The Pearson correlation coefficient was generated to demonstrate the relationship between the proportion of women faculty members and speakers in the meetings. Statistical analysis was performed using Stata V14.2, with statistical significance set at p < 0.05. The survey instrument used to collect data on women's representation in gastroenterology, hepatology, and endoscopy conferences between 2018 and 2022 is provided as Supplementary Data S1.

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TABLE 1 Statistics of women faculty members from 2018 to 2022.

	2018, n (%)	2019, n (%)	2020, n (%)	2021, n (%)	2022, n (%)
Overall representation in each role
Women faculty (chairpersons, moderators, speakers, OC)	74 (14.1)	95 (13.7)	121 (14.8)	132 (17.1)	197 (15.2)
Women chairpersons	16 (6.6)	15 (5.5)	21 (6.0)	17 (6.7)	36 (6.7)
Women moderators	7 (26.9)	11 (12.2)	16 (21.9)	15 (20.8)	29 (23.2)
Women speakers	30 (16.1)	45 (18.0)	56 (18.5)	64 (19.5)	95 (18.4)
Women organizing committee (OC)	21 (28.8)	24 (29.3)	28 (29.8)	36 (31.3)	37 (31.9)
Representation in each country/region
Women faculty (including chairpersons, moderators, speakers, OC)
Hong Kong	18 (19.8)	19 (19.0)	18 (25.0)	24 (23.3)	20 (19.8)
Japan	13 (6.1)	10 (4.1)	19 (7.1)	15 (6.4)	9 (3.8)
Thailand	29 (30.5)	29 (29.3)	27 (30.0)	32 (33.0)	37 (34.3)
Vietnam	2 (11.8)	23 (18.5)	26 (23.0)	40 (24.5)	47 (22.1)
Pakistan	12 (10.8)	14 (11.0)	14 (9.2)	13 (11.9)	19 (12.4)
India	NA	NA	17 (13.5)	8 (12.9)	65 (13.5)
Women moderators
Hong Kong	1 (33.3)	1 (9.1)	0 (0)	0 (0)	0 (0)
Japan	NA	NA	0	NA	7 (24.1)
Thailand	3 (27.3)	1 (8.3)	3 (42.9)	2 (18.2)	3 (25.0)
Vietnam	NA	8 (15.4)	9 (21.4)	12 (26.7)	13 (20.3)
Pakistan	3 (25.0)	1 (6.7)	4 (26.7)	1 (10.0)	6 (37.5)
India	NA	NA	0 (0)	NA	7 (24.1)
Women chairpersons
Hong Kong	6 (16.7)	5 (15.2)	7 (31.8)	6 (21.4)	6 (19.4)
Japan	5 (3.3)	6 (3.3)	6 (3.2)	7 (4.0)	4 (2.3)
Thailand	NA	NA	NA	NA	NA
Vietnam	NA	1 (14.3)	0 (0)	0 (0)	1 (10)
Pakistan	5 (9.4)	3 (5.9)	4 (5.5)	4 (9.1)	3 (3.7)
India	NA	NA	4 (6.3)	NA	22 (9.1)
Women speakers
Hong Kong	8 (19.5)	10 (21.7)	7 (20.6)	13 (23.6)	10 (19.2)
Japan	8 (13.3)	4 (6.3)	13 (16.9)	8 (13.3)	5 (7.7)
Thailand	8 (34.8)	13 (38.2)	6 (25.0)	10 (43.5)	10 (41.7)
Vietnam	2 (11.8)	8 (17.0)	11 (24.4)	18 (24.3)	25 (22.7)
Pakistan	4 (8.9)	10 (16.7)	6 (9.4)	7 (13.0)	9 (16.4)
India	NA	NA	13 (22.4)	8 (12.9)	36 (17.2)
Organizing committee women
Hong Kong	3 (27.3)	3 (30.0)	4 (33.3)	5 (35.7)	4 (28.6)
Japan	NA
Thailand	18 (29.5)	15 (28.3)	18 (30.5)	20 (31.7)	24 (33.3)
Vietnam	NA	6 (33.3)	6 (27.3)	10 (27.0)	8 (27.6)
Pakistan	0 (0)	0 (0)	0 (0)	1 (100)	1 (100)
India	NA

Results

It is observed that between 2018 and 2022, the percentage of women's representation as chairpersons, moderators, speakers, and OC members has slightly increased from 14.1% to 15.2% (Figures 2 and 3). However, this increase was not statistically significant. The percentage of women as OC members was the highest, followed by moderators, speakers, and the lowest were chairpersons. In 2018, the participation of women as chairpersons, moderators, speakers, and OC was 6.6%, 26.9%, 16.1%, and 28.8%, respectively, whereas in 2022, the participation of women as chairpersons, moderators, speakers, and OC members was 6.7%, 23.2%, 18.4%, and 31.9%, respectively. The percentage of women serving as chairpersons and OC members observed a slight change over 5 years. From 2018 to 2022, the percentage of women moderators decreased (from 26.9% to 23.2%). Regarding women speakers, their percentage increased from 16.1% in 2018 to 19.5% in 2021 before a minor drop to 18.4% in 2022.

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Even in Asia, there were regional differences observed. Between 2018 and 2022, in East Asia, the percentage of women involved as chairpersons, moderators, speakers, and OC members were 4.85%–6.4%, 0%–33.3%, 12.8%–18.3%, and 27.3%–35.7%, respectively. It was observed that the rate of women involved was highest in the period between 2020 and 2021, and the overall participation of women in Hong Kong, China, was higher than in Japan. We have observed that women's representation in Japan decreased from 6.1% in 2018 to 3.8% in 2022. In detail, the highest percentage in Hong Kong, China, for women chairpersons was 31.8% (2020); women speakers was 23.6% (2021) and OC members was 35.7% (2021). This rate in Japan was 4.0% (2021) and 16.9% (2020), respectively.

In South Asia, the percentage of women faculty members was 9.2%–13.5%. The percentage of women faculty members in India was almost unchanged, and in Pakistan, it increased slightly from 10.8% in 2018 to 12.4% in 2022.

In Southeast Asia, the percentage of women faculty members was 11.8%–34.3%, and Thailand outperformed Vietnam for 5 years. However, the increasing rate of participation among Vietnamese faculty members was observed. In detail, the percentage of women faculty members in Thailand increased from 30.5% in 2018 to 34.3% in 2022, but in Vietnam, the increment almost doubles from 11.8% in 2018 to 22.1% in 2022. For the percentage of women speakers from 2018 to 2022, it increased in both Thailand and Vietnam. For the percentage of women OC members, it increased in Thailand contrasted with a slight decrease in Vietnam. The percentage of women moderators in Vietnam tended to increase from 15.4% to 20.3%, but in Thailand, it tended to decrease from 27.3% to 25.0%. In addition, the highest rate of women moderators reached 42.9% in 2020 in Thailand.

Data on the president's role were only available in Vietnam and Thailand, and there were women presidents in both countries in some years between 2018 and 2022. Between 2018 and 2019, only one woman who served as a president in the last five terms in Thailand. A similar situation was observed in Vietnam. However, in 2022, half of the presidents in Vietnam were women.

Our analysis revealed variations in women's representation across different types of conferences. Specifically, in gastroenterology conferences, women constituted approximately 14.5% of the faculty roles. In hepatology conferences, the representation was slightly higher at 16.0%. Endoscopy conferences had the lowest representation, with women making up only 12.3% of the faculty roles. These variations indicate that women's participation is not uniform across different specialties within the field of gastroenterology, necessitating targeted efforts to address these disparities.

Discussion

Gender disparities have been a significant problem in many fields of medicine. As gender equality has been one of the important sustainable development goals (SDGs) [17], several studies have been done to clarify the extent of the problem. In 2007, a survey among US gastroenterologists revealed that women in academia had more difficulty in their career advancement and promotion [18]. While the proportion of women and men in senior fellows, assistant professors, and associate professors' roles did not significantly differ, the proportion of male professors was notably higher. Recent studies in the U.S. have highlighted a lower h-index among women in assistant professors and chairpersons roles [19] and lesser representation in education and training [20]. Furthermore, men predominantly occupy editor-in-chief positions, editorial board memberships, and senior authorships in high-impact gastroenterology journals [21]. Data from the UK during 2013–2015 also showed a lower number of women speakers, leaders, and chairs despite an increasing number of women gastroenterologists [22].

So far, there have been limited data demonstrating gender disparity in Asia except that one of the studies rigorously investigates the persistent gender disparities within the realm of academic gastroenterology and hepatology conferences in Pakistan. It highlights a stark underrepresentation of women in invited faculty and leadership positions, with females comprising only 11.9% of invited roles compared to 88.1% for males. The entrenched male dominance, particularly in leadership roles, calls for a comprehensive strategy to address and mitigate these gender inequities [23].

As a result, we conducted a multinational study of the gender disparities in gastroenterology and their academic roles across the countries in Asia. To demonstrate the gender representation in academia, we focused on the gender distribution among the moderators and speakers in each country's academic meeting as these specialty societies act as gatekeepers, providing clear examples of individuals recognized in their field. These individuals often serve as role models for young physicians. The problem of women's representation on professional panels, particularly the prevalence of all-male panels or “manels,” has sparked increased discussion in the broader scientific community [24]. However, across multiple specialties at national conferences, women are under-represented among invited speakers [25–31]. Apart from the women roles as the speakers and moderators in the national conferences, we also analyze the number of women presidents of the national gastrointestinal societies as these are the best representatives for the leadership.

Our study showed that, in East, South, and Southeast Asian countries, the participation and proportion of women served as chairpersons, moderators, speakers, and OC members in gastroenterology, hepatology, and endoscopy conferences is still low. During the study period from 2018 to 2022, there has been an increase in the number of women speakers in most countries except for Japan. This could reflect different cultural practice in Japan with regard to women and at the same time show an increasing concern over gender disparity. The number of women presidents of the national society was available in Vietnam and Thailand, both of which showed less gender disparity than in other countries. The findings in our study are like those reported in the western countries [21, 22, 24–29]. These results are not so surprising when considering Asian cultures, which expect women to be more modest and act in a supportive role for males. This finding reflects differences in each country's culture in accepting the changing global trend toward gender equality. The presence of women president of the society as observed in Thailand and Vietnam was associated with less gender disparity, which implied the influence of women role model in both countries. Moreover, in some countries such as Thailand that are composed of extended family, family support in child care helps the women to work with less family burden when compared with countries that are composed mainly of nuclear family. Further analysis indicated that women's representation differs among various types of conferences. Gastroenterology conferences showed slightly higher representation of women compared to endoscopy conferences. This suggests that specific cultural and institutional barriers may be more pronounced in certain subspecialties. Future efforts to promote gender equity should consider these differences and implement tailored strategies to support women's participation in all areas of gastroenterology, hepatology, and endoscopy.

There are several potential barriers that may hinder women's participation in conference roles such as implicit biases, institutional practices, and cultural norms. Although a higher proportion of women pursue the academic role when compared with men (40% vs. 25%) [32], they were more likely to hold a lower academic rank and get less promotion [33, 34]. Interestingly, women leaders still perceive a great amount of bias, with 46% of pay inequality and 41% disparate treatment by patients [35]. Although this study was conducted during the COVID-19 pandemic, we did not analyze the impact of the COVID-19 pandemic in this study, nor did we consider whether the conferences were held virtual or onsite as the data collection started before the pandemic. The data regarding the number of female members serving as moderators, chairpersons, speakers, and presidents at conferences was extracted from annual conferences. Studies show that the impact of the COVID-19 pandemic on gender imbalance in teaching and scientific research was primarily due to the increased role of women in childcare and household responsibilities, leaving them with less time to engage in other activities [36, 37]. However, in the dataset we collected, there was no decline in the proportion of female members at conferences compared to the years before the COVID-19 pandemic.

Our main limitations include conducting the surveys in only two representative jurisdictions in each region, and our data have been collected for only 5 years. A longer period and a larger number of included countries might better demonstrate the gender disparity in the field of gastroenterology. Also, we did not explore the obstacles that could extrapolate the reasons of women underrepresentation. This calls for measures to promote the roles of women in academic and scientific activities in gastroenterology. Due to constraints in resources and time, qualitative methods such as interviews or focus groups were not conducted, which limits the depth of understanding of the underlying reasons for observed patterns in women's representation.

To increase women participation in the future gastroenterology, hepatology, and endoscopy conferences, we propose several measures. The first measure is to have a diverse selection committee for the conferences to facilitate and select more women to participate in the conferences as a study in the US showed an increasing number of women speakers when there were more number of women organizing the conference [15]. Also, the selection for awards and funding should be done through the gender-neutral reviewing process [38]. The second measure is to apply inclusivity and diversity for mentorship programs at the early stage of clinician's career. This can promote the development of women role model, which can further encourage the younger generation to overcome the gender barrier. Thirdly, an outreach effort to highlight opportunities for all women should be addressed at multilevel. In addition to that, encouragement for the visibility of successful women in the field of gastroenterology, hepatology, and endoscopy should be created in an inclusive environment to foster interest and confidence among other potential participants. With an increasing impact of social media, the women leadership can be promoted more widely, using the social media to gain more insight and distribution of their research. These social media have become one of the important tools not only for social communication but also for medical education and professionalism [39]. Fourth, to encourage more women participation in academic conference, a family-friendly meeting program should be adopted. This can be conducted in several ways. For example, providing childcare options, more flexible schedule, or providing virtual meeting [40]. Finally, the role of employers to promote flexible scheduling, job sharing, and provision of child support to accommodate diverse professional commitments is also advisable. With the increasing role models and a chance to become one of the society members would have encouraged more women leaders and promote more women leadership. To achieve this, there have been several women support initiatives across the globe, such as Supporting Women in Gastroenterology section of the British Society of Gastroenterology, Women in Endoscopy (WIE), Scrubs and Heels (S&H), Women in Gastroenterology Network Asia-Pacific (WIGNAP), and Women-in-GI (WinGI) Focus Group under the auspices of the Emerging Leaders Committee, Asian Pacific Association of Gastroenterology (APAGE). These groups are now working to promote female leadership and offering valuable insights for identifying effective strategies to address the under-representation of women [3].

In conclusion, our study showed significantly under-represented participation of women in gastroenterology and hepatology annual scientific conferences, particularly in the endoscopy field, in East, South, and Southeast Asia as chairperson, moderator, speakers, and OC. This calls for measures to promote the roles of women in these meetings for their future career advancement.

Acknowledgments

Jalpa Devi: funding from Lawrence C. Pakula for the Advanced IBD Fellowship.

Conflicts of Interest

Dr. Rashid Lui is the social media editor of JGH and a member of the editorial board of JGH. To minimize bias, he would be excluded from all editorial decision-making related to the acceptance of this article for publication. The other authors disclosed no conflict of interest relevant to this publication otherwise.

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