Hi, my name is Uma Mahajan, and I am a first-year medical student at Case Western Reserve University. Our project is titled, Gender Bias is Not Present in the Neurosurgery Peer Review Publication Process, a study on authorship trends in two leading neurosurgical journals between 2010 and 2019. In recent years, there have been increased efforts to recruit and retain underrepresented groups, including women, in academic medicine. These efforts include identifying and reducing unconscious biases that may prevent minority groups from advancing. In neurosurgery in particular, women have historically been and currently are underrepresented, comprising under 10% of board-certified neurosurgeons, so gender bias may serve as a barrier to academic advancement. Publications are vital to academic advancement, and recent studies have demonstrated a gender publication gap in high-impact medical journals and academic surgery in particular. It is possible that bias, including unconscious bias, in the peer review processes contributes to the gender gap in publications, since many journals use a single blind peer review process in which reviewers know the authors' names and institutions. In 2011, neurosurgery initiated a double-blind peer review process in which reviewers are blinded to the authors' names and institutions to better insulate against any possible biases. Understanding current publication trends and the potential presence of bias are critical so that the potential of underrepresented groups can be better realized. We sought to assess the current status of women in academic neurosurgery publications, and our goal was three-fold. First, we surveyed female first and senior authorship rates in two premier neurosurgical publications, JNS and Neurosurgery, over the last decade. Second, we analyzed whether double-blind peer review altered female authorship rates relative to single-blind review. Third, we evaluated how female authorship rates compared to the number of women entering neurosurgery residency and obtaining American Board of Neurological Surgery certification over the same time period. We manually collected data from articles published in JNS and Neurosurgery. We collected data on first and senior author gender, neurosurgery subspeciality, and article type. In addition, we collected data on gender of entering residents for five years in this time period. We also collected data on ABNS certification for each year during this decade by acquiring the Find a Neurosurgeon tool on the ABNS website for all 50 states. From 2010 to 2019, a total of 2,055 articles were analyzed, with 1,015 in JNS and 1,040 in neurosurgery. Of this total, 13.1% of first authors and 6.3% of senior authors were women. Overall, there was no statistically significant difference in publications authored by women between the journals during the combined 2010-2019 time point. There was no significant difference in the proportion of women authors in neurosurgery between one year before the double blinding peer review was initiated and one year after the double blinded peer review process was implemented. We found that women were less likely to author invited papers compared to non-invited papers. Women made up 14.7% of first authors on non-invited articles compared to 7% of first authors on invited articles. We also found a significant correlation between women first and last authors. In publications in which the senior author was a woman, the odds of the first author being a woman was increased by twofold. When categorizing articles by subspecialty, there was no significant difference in proportion of women between subspecialties. We also examined the effect of country of institution on author gender. We found there was no difference in likelihood of a first author from a U.S. institution being a woman versus likelihood of a first author from a non-U.S. institution being a woman. Our entering resident data analysis showed the rate of women entering neurosurgery residency increased from 11.2% in 2009 to 23.6% in 2018. Though this rate doubled in the 10-year time frame, the increase over time was not statistically significant, which may be attributed to the small sample size. We found that from 2010 to 2019, the rate of women achieving ABNS certification increased from 5.3% to 6.8%, which was statistically significant. We also calculated the percentage of ABNS certified neurosurgeons who are women by state, the majority of which were under 10%. Across the decade, the percentage of female first authors, 13.1%, was significantly lower than the rate of women entering neurosurgery residency, 18%. However, the percentage of female last authors, 6.3%, closely parallels the rate of female ABNS certified neurosurgeons at 6.2%. The study is limited in that we investigated only two specific neurosurgical journals, as well as a restricted time period and sample size. Our finding that the percentage of entering women residents was greater than the percentage of female first authors may reflect an increase in female first authors in the future. However, our conclusions are limited since we did not examine trends in current residents or the level of training of the first author. Additionally, there were some names that we could not classify by gender, and some names that we may have misclassified. In conclusion, first, we found that different peer review processes at JNS and neurosurgery were not associated with differences in publication rates by gender. Second, last authorship mirrored the percentage of women achieving ABNS certification. Third, the percentage of women entering neurosurgery residency was greater than the percentage of first authors who were women. Fourth, women are publishing invited manuscripts at a much lower rate than non-invited manuscripts. Finally, there was a significant correlation between first and last author gender. The first author was twice as likely to be a woman when the senior author was a woman, suggesting the importance of female mentorship in promoting the success of younger women in academic neurosurgery. To fully realize the advancement of women in academic neurosurgery, we must continue to improve mentorship for women, increase high-quality research opportunities, and eliminate perceived and existing barriers. I'd like to thank all of the amazing authors on this project for their crucial assistance and guidance, Paris, Harsh, Judy, Sammy, Dr. Benzel, and Dr. Zigurekis. If you have any questions or comments or want to collaborate in the future, please reach out to me via email. Also, please look out for our upcoming manuscripts. Thank you for watching this presentation.

gender bias

neurosurgery

peer review

authorship trends

academic neurosurgery