Women Speak Up Less at Grand Rounds, Even in a Virtual Setting

Female attendees of virtual ophthalmology grand rounds sessions were significantly less likely than their male counterparts to ask questions of the speaker, according to a prospective single-center cohort study.

Over the course of 1 year of grand rounds, the number of questions asked at a session by women averaged 1.3 (95% CI 1.0-1.7) compared with 3.2 questions from men (95% CI 2.7-3.7), reported Gerami D. Seitzman, MD, of the University of California San Francisco, and co-authors.

Men were much more likely to ask the initial questions at the sessions as well, with the prevalence ratio increasing from 1.7 (P=0.16) to 2.6 (P<0.001), and 3.1 (P<0.001) for the first, second, and third questions, respectively.

And it wasn’t that there were fewer women present. At the 46 ophthalmology grand rounds sessions studied, females accounted for 42% of speakers, 55% of moderators, and 47% of attendees. The study took place from April 2020 through April 2021, when the COVID-19 pandemic necessitated use of virtual grand rounds. Attendees and speakers were unaware of the study at the time of the sessions.

“This study demonstrates that differences persist even when academic meetings, such as GR [grand rounds], are held in a less formal online setting,” Seitzman and team wrote in JAMA Ophthalmology.

“The findings in this study are consistent with others demonstrating that women in academia ask fewer questions than men,” they noted; this has been observed “regardless of their representation in the audience and when adjusted for seniority of the question-asker.”

“Dynamic interaction with colleagues at professional conferences is integral to career development, models productive academia, and publicly reinforces the credibility of the questioner,” the researchers noted.

The findings highlighted “another part of our academic life that deserves intentional discussion and remediation,” Julia A. Haller, MD, of the Wills Eye Hospital at Thomas Jefferson University in Philadelphia, wrote in an accompanying editorial.

“Scholarship continues to document disparities in our field, including now in post-grand rounds discourse,” Haller noted. She referenced the 2015 New York Times opinion piece in which Cheryl Sandburg, then the chief operating officer of Facebook, and Adam Grant, PhD, of the University of Pennsylvania in Philadelphia, wrote that “when a woman speaks in a professional setting, she walks a tightrope. Either she’s barely heard or she’s judged as too aggressive.”

There is a paucity of proven corrective strategies, although “there is evidence that more women in leadership positions may help. Awareness of the issue and intentionality is also important,” Haller wrote. “Offering women the floor will elevate our discussions, by equitably involving all worthy contributors. It must be rewarding, rather than risky, to speak while female,” she concluded.

Of 140 questions asked during 1 year of virtual academic grand rounds in ophthalmology, female attendees asked 40 questions (29%, 95% CI 20-35) and male attendees asked 100 questions (71%, 95% CI 65-80).

Notably, the proportion of female participation increased to 40% when researchers excluded 41 questions asked by one voluble male participant at the sessions.

For the study, Seitzman and co-authors observed synchronous video grand rounds presentations of all UCSF departments that allowed for interactive speaker questioning during each grand rounds presentation — in total, 46 grand rounds presentations were included: 31 for ophthalmology, 10 for obstetrics and gynecology, and five for otolaryngology–head and neck surgery.

“Results were calculated for all GR specialties, though the analysis and discussion focused on ophthalmology, since the sample size was higher,” authors explained.

Additional data collected included the sex of each grand rounds attendee, moderator, and speaker as well as whether the speaker was introduced as “doctor” when indicated, which Seitzman and colleagues said occurred in 28 of 31 of the ophthalmology grand rounds.

Although age data were not included in this study, previous studies have reported an age-related decline in classroom participation, authors said. Others have suggested discrimination and an unwelcome reception during women’s education and professional careers may contribute to their relative reticence in these settings, the team noted. The effect of additional household and family demands on women during the COVID-19 pandemic was also a likely contributing factor, they added.

While the sex of the speaker did not influence the likelihood that female attendees would ask a question, with male-to-female prevalence ratios of 3.1 for both female and male speakers, the team suggested that “promoting diversity in GR speaker selection is important as it may influence who speaks up and engages in academic conversation during GR discussions.”

Authors noted study limitations included being performed in a single center, being limited to online grand rounds only, primarily in ophthalmology, and the oversimplification of participants’ presumed sex based on appearance or identification name.

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