The term gender gap (GG), coined by E. Smeal in 1980, is an empirical and analytical construct which refer to the difference between categories of a variable in relation to male and female rates.1 Scientific publications (SP) are a measure of success in academic medicine.2 In the last decade a few articles have been published on the GG in SP.3,4 Our aim is to determine whether GG exists in the SPs of Cirugía Española, the only Spanish general surgery journal indexed in Pubmed.
MethodsWe conducted a literature review in Cirugía Española, including all SPs from the years 2000, 2010 and 2020. The following data were collected: gender, first and last author, type of article (special article, scientific letter, editorial, image of the month/video, innovation in surgical technique, original and systematic review); area of training (AT) (bariatric, carcinomatosis, major outpatient surgery, colorectal, endocrine, oesophagogastric, management/quality, hepatobiliopancreatic, infections, breast, oncology, wall, thoracic surgery, transplant, trauma/urgencies, vascular surgery, and others); multicentre article (yes/no); hospital level (1/2/3), existence of residency programme and seniority (<10 years, >10 years), autonomous community and province. The SPs were reviewed online at the Spanish Surgery website (https://www.elsevier.es/es-revista-cirugia-espanola). The AEC was asked for the gender distribution of its associates. A 50% male/female distribution was considered fair. An association analysis was performed on frequencies and prevalences observed with the expected frequencies using the non-parametric Chi-square X2 test for nominal or qualitative variables. Statistical analysis was performed with SPSS v.25®.
ResultsThe rate of female AEC members has progressively increased from 18.3% in 2000 to 42.7% in 2020. The literature review included a total of 673 CPs. Of these, 291 (43.2%) correspond to 2000, 217 (32.2%) to 2010, and 165 (24.5%) to 2020. In 2000, 10% of the first authors were female, 29.5% in 2010 and 44.2% in 2020. The female gender of the last author was 10.7%, 13.8% and 15.2%, respectively (Fig. 1A and B).
Regarding the relationship between article type and first author, we observed that the subtypes closest to equity were image/video of the month (40.7%) and scientific letter (37.3%). As last author, the highest percentage of female gender was in image/video of the month (18.5%) and the lowest was in special article (0%) and editorials (4.5%) (Fig. 1C and D). The results by CA showed that the only section with an increasing trend in terms of female first authorship was Colorectal with 12% in 2000, 30% in 2010 and 42.9% in 2020. It is noteworthy that there is no female representation either as first or last author in the management/quality area. Only infections in 2010 (60%); trauma/urgencies 2010 (54.4%); oncology 2020 (75%) and vascular 2020 (58.3%) managed to overcome the equality barrier.
We performed an analysis of the first author/last author binomial classifying it as Female/Female (F/F), Female/Male (F/M), Male/Female (M/F) and Male/Male (M/M). We obtained 3.3% of F/F, 21.4% of F/M, 9.5% of M/F and 65.8% of M/M. The modality that increased the most during the period studied was F/F representation (Table 1).
Distribution of frequencies by gender and first/last author.
| First female author n ( %) | First male author n (%) | p value | Last female author n (%) | Last male author n (%) | Total n | p value | |
|---|---|---|---|---|---|---|---|
| Total bibliographic review | 166 (24.7) | 507 (75.3) | 86 (12.8) | 587 (87.2) | 673 | .329 | |
| Year | <0.001 | ||||||
| Year 2000 | 29 (10) | 262 (90) | 31 (10.7) | 260 (89.3) | 291 | ||
| Year 2010 | 64 (29.5) | 153 (70.5) | 30 (13.8) | 187 (86.2) | 217 | ||
| Year 2020 | 73 (44.2) | 92 (55.8) | 25 (15.2) | 140 (84.8) | 165 | ||
| Type of article | <.001 | .258 | |||||
| Special article | 4 (14.3) | 24 (85.7) | 0(0) | 28 (100) | 28 | ||
| Letter to the editor | 18 (17.5) | 85 (82.5) | 14 (13.6) | 89 (86.4) | 103 | ||
| Scientific letter | 66 (37.3) | 111 (62.7) | 29 (16.4) | 148 (83.6) | 177 | ||
| Editorial | 5 (22.7) | 17 (77.3) | 1 (4.5) | 21 (95.5) | 22 | ||
| Image/video of the month | 22 (40.7) | 32 (59.3) | 10 (18.5) | 44 (81.5) | 54 | ||
| Surgical technique innovation | 2 (9.1) | 20 (90.9) | 2 (9.1) | 20 (90.9) | 22 | ||
| Original | 46 (20.4) | 180 (79.6) | 26 (11.5) | 200 (88.5) | 226 | ||
| Systematic Review | 3 (15) | 17 (85) | 2 (10) | 18 (90) | 20 | ||
| Training area | .072 | .507 | |||||
| Bariatrics | 2 (18.2) | 9 (81.8) | 0(0) | 11 (100) | 11 | ||
| Carcinomatosis | 1 (100) | 0(0) | 0(0) | 1 (100) | 1 | ||
| CMA | 0(0) | 3 (100) | 0(0) | 3 (100) | 3 | ||
| Colorectal | 24 (23.8) | 77 (76.2) | 15 (14.9) | 86 (85.1) | 101 | ||
| Endocrinology | 9 (27.2) | 25 (72.7) | 4 (12.5) | 30 (87.5) | 34 | ||
| Esophagogastric | 10 (23.3) | 33 (76.7) | 4 (9.3) | 39 (90.7) | 43 | ||
| Management/quality | 0(0) | 14 (100) | 2 (14.3) | 12 (85.7) | 14 | ||
| HBP | 25 (27.2) | 67 (72.8) | 9 (9.8) | 83 (90.2) | 92 | ||
| Infections | 13 (40.6) | 19 (59.3) | 6 (19.4) | 26 (80.6) | 32 | ||
| Breast | 6 (23.1) | 21 (76.9) | 2 (7.7) | 25 (92.3) | 27 | ||
| Oncology | 6 (33.3) | 12 (66.7) | 3 (16.7) | 15 (83.3) | 18 | ||
| Wall | 11 (23.4) | 36 (76.6) | 10 (21.3) | 37 (78.7) | 47 | ||
| Chest | 5 (27.8) | 13 (72.2) | 4 (22.2) | 14 (77.8) | 18 | ||
| Transplant | 2 (16.7) | 10 (83.3) | 1 (8.3) | 11 (91.7) | 12 | ||
| Trauma emergencies | 22 (34.4) | 42 (65.6) | 7 (10.9) | 57 (89.1) | 64 | ||
| Vascular | 11 (36.7) | 19 (63.3) | 5 (16.7) | 25 (83.3) | 30 | ||
| Others | 19 (15.2) | 106 (84.4) | 13 (10.4) | 112 (89.6) | 125 | ||
| Type of Hospital | .007 | .722 | |||||
| Level 1 | 0(0) | 100(3) | 0(0) | 100(3) | 3 | ||
| Level 2 | 17.6(18) | 82.4(84) | 13.7(14) | 86.3(88) | 102 | ||
| Level 3 | 23.3(146) | 72.7(388) | 12.4(66) | 87.6(468) | 534 | ||
| Residency programme | .001 | .05 | |||||
| Yes <10 Years | 0(0) | 6 (100) | 3 (50) | 3 (50) | 6 | ||
| Yes >10 Years | 153 (28) | 394 (72) | 68 (12.4) | 479 (87.6) | 547 | ||
| No | 11 (13.6) | 70 (86.4) | 12 (14.8) | 69 (85.2) | 81 | ||
| Multicentre | .912 | .089 | |||||
| Yes | 5 (20.8) | 19 (79.2) | 1 (4.2) | 23 (95.8) | 24 | ||
| No | 122 (25.1) | 365 (74.9) | 60 (12.3) | 427 (87.7) | 487 | ||
| Nc | 36 (24.7) | 110 (75.3) | 25 (17.1) | 121 (82.9) | 146 |
MOS, major outpatient surgery; HBP, hepatobiliopancreatic.
Our analysis shows first and last authored GG in SPs, although there is a progressive increase in the number of SPs as first author. Other articles on GG have shown the same tendencia.5 This increase is minimal as last author, a position often reserved for the head of service. This could be due to the phenomenon known as the "glass ceiling" or the limitation of women's promotion to managerial positions.6
The analysis by type of article showed inequality in all subtypes but especially in editorials, innovation in surgical technique, special article and systematic reviews. The most recent types (picture/video of the month and scientific letter) were the closest to equality. This has also been observed in GG studies from other specialties with lower numbers of original studies and editorials by women.2
Studies on BG have shown that when the first author is a man, it is more likely that the last author is also a man.3 We found 65.8% M/M authors vs. 3.3% F/F authors. The combination that grew the most was F/F from 0.3% in 2000 to 7.3% in 2020.
There are multiple theories about GG. The most recognised is the so-called "leaky pipeline" which describes how women start an educational and professional career, and then drop out for a variety of social and professional reasons.7 Possible solutions to reduce GG are: elimination of informal networks in selective processes, with formal, structured and transparent recruitment; increase of women researchers as it could cause the "gender pull phenomenon" or inclusive mentoring.8–10
Our study has limitations: exclusive review of Cirugía Española and not of the entire scientific production, and the absence of reliable data on the distribution by gender and CA of Spanish surgeons. But we believe that its strength is that it is the first Spanish study on GG in SP.
In conclusion, we have observed GG in Spanish Surgical SP in terms of first and last authorship. It would be desirable to develop AEC-sponsored policies to reduce GG.
Please cite this article as: Carbonell Morote S, Villodre C, Baeza Carrión A, Duque Álvarez NX, Manuel Ramia J. Brecha de género en las publicaciones de Cirugía Española. Cir Esp. 2022. https://doi.org/10.1016/j.ciresp.2022.05.011
