The World Health Organization (WHO) defines gender as “the socially constructed characteristics of women and men – such as norms, roles and relationships of and between groups of women and men.”1 (para.10) The existence of gender norms can become problematic if they lead to inequality when used to justify differential treatment between groups or the discrimination and social exclusion of individuals who do not conform to cultural gender norms.1 One classic example of this is the gender gap in science and mathematics: research shows that the majority of the population hold implicit biases that associate mathematical and scientific competency with maleness or masculinity, and that this stereotype can negatively influence girls’ and women's belief in their ability or desire to pursue a career in this field.2,3
Although the gender demographics of universities have shifted and women now regularly outnumber men at the undergraduate and graduate levels and in many professional schools,4,5 the characteristics of leaders in health research in academic institutions fail to reflect this demographic shift, even considering that ample time has passed for this change to occur.6,7 The disparity is more pronounced when examining equity across gender, racial, socioeconomic, and other social identities. The persistence of inequity despite efforts to diversify participation in academic health research and leadership, points to something deeper than a pipeline issue or simple lack of candidates; it represents a lost opportunity to utilize the productivity and contributions of all genders, which can lead to a lack of diverse role models and mentors for new researchers.6-8
Many universities and research agencies have established diversity initiatives and have begun to report on equity within their institutions to increase transparency and draw attention to gender disparities internationally.9 Agencies that have implemented such policies include the Tri-Agency Institutional Programs Secretariat's Advisory Committee on Equity, Diversity and Inclusion Policy (ACEDIP), and the Athena Scientific Women's Academic Network (SWAN) initiative in the United Kingdom, recently adapted and implemented in Australia as the Science and Gender Equity (SAGE) program.10-12 In 2019, the Tri-Agency in Canada, a group of three main federal research funders, called on academic institutions to implement the Dimensions Charter to promote equity, diversity, and inclusion across multiple dimensions of individual characteristics that may influence how people interact with academic systems, structures, and the people within them.12 These approaches show a willingness to acknowledge and address systemic inequities, but there is a lack of synthesized evidence on this subject, which limits reliable evidence-based decision-making or policy development. Completing this synthesis of the literature is essential not only to deepen our understanding of gender inequity, but also to be a fundamental step in developing quality indicators to monitor equity in academic health research and assess the effectiveness of interventions to inform future policy development.
While much of the available evidence on gender equity approaches the issue in binary terms and focuses on the representation of women and men, the authors’ intention is to use an inclusive approach to gender identity. The specific working definition of gender equity includes equal rights and opportunities for individuals of all genders to participate fully in society and have their behaviors, wants, and needs valued on an individual basis rather than on socially constructed gender roles.13 However, the authors acknowledge that reviews are inherently limited because they must work with and report on the available evidence, whether or not it aligns with this definition.
The goal is to conduct a living scoping review to enable continuous surveillance and synthesis of the globally available evidence of gender inequity among individuals with appointments in academic institutions that conduct health research for any type of outcome.14 Furthermore, where available, the authors will examine how different social identities intersect with gender to influence outcomes.15 They did not identify reviews that addressed gender representation in academic health research from a global perspective through the scoping searches completed in PubMed.
The primary question of this review is: What is the global evidence of gender inequity among individuals with appointments at academic institutions that conduct health research?
The secondary question of this review is: How do gender and other identities intersect to influence outcomes among individuals with appointments at academic institutions that conduct health research?
This review will consider studies that include individuals appointed at academic institutions that conduct health research. Relevant participants will include individuals with any kind of employment that enables them to conduct health-related research. Other types of organizations, such as research science councils, that are affiliated with a governmental organization but are not academic institutions will be excluded.
This review will consider studies that describe gender inequity, including any outcomes related to gender equity (Table 1 ).
This review will consider studies conducted in academic institutions that conduct health research. The context of health research in this review is based on the four pillars defined by the Canadian Institutes of Health Research (CIHR): i) biomedical; ii) clinical; iii) health services; and iv) social, cultural, environmental, and population health.16 Academia and academic institutions will be defined as follows:
- Academia: the environment or community concerned with the pursuit of research and scholarship17
- Academic institution: university, college, or institute with a formal partnership/affiliation with a university or college
Types of sources
This review will consider primary research studies of quantitative, qualitative (eg, narrative, phenomenological, grounded theory), and mixed methods designs.18 Experimental (eg, randomized controlled trials), quasi-experimental (eg, non-randomized controlled trials, controlled before and after studies, interrupted time series), and observational (eg, cohort studies, case-control studies, cross-sectional studies, case series, case reports) designs will be considered. No restrictions based on study year, language of publication, study duration, or publication status will be applied.
Protocol and registration
The protocol for this living scoping review was developed in accordance with the JBI Manual for Evidence Synthesis and the Cochrane Collaboration's guidance for living scoping reviews.14,18 This approach was selected because the authors expect this to be a dynamic body of literature where new evidence emerges on a regular basis. Broadly speaking, the conduct of a living scoping review entails regular surveillance of the published literature to determine when sufficient new evidence has amassed to warrant updating a review.14 The final review will be reported using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for scoping reviews (PRISMA-ScR) checklist.19 The protocol for this scoping review was also registered in the Open Science Framework (https://osf.io/8wk7e/).
Consultation exercise and integrated knowledge translation approach
This review will use an integrated knowledge translation approach, where researchers and knowledge users co-create research to ensure that it is relevant and useful to knowledge users and will increase the likelihood of uptake.20 An integrated knowledge translation approach is relevant in this context as many members of the research team are academic health researchers and thus function in a dual role of investigator and knowledge user. The knowledge users include members of the Canadian Academy of Health Sciences; leaders of Canada's research-intensive universities; the science publisher Elsevier; an editor from The Lancet; and members of the WHO, SAGE, and the South African Medical Research Council (SAMRC). The knowledge users have provided input to the funding application, research question, and protocol, and will be engaged throughout the project through monthly updates and invitations to review and provide feedback on project documents (eg, search strategy, screening, charting forms). They also have connections to broad networks of potential collaborators who will be invited to an in-person meeting to prepare key messages and develop an evidence-based knowledge translation strategy to disseminate results to relevant audiences. Furthermore, we will engage knowledge users in a modified online Delphi exercise to identify and prioritize topics for future research in academic health as well as other disciplines.21 At the end of the study, we will assess knowledge user engagement through completion of the Patient and Public Engagement Questionnaire, an instrument with good construct validity.22,23
Conceptual and theoretical frameworks
This review will primarily use a feminist theoretical model to provide context for the project and inform the approach to data extraction and presentation. Additionally, it will use a theoretical model for analyzing gender bias in medicine, which hypothesizes that active efforts to raise awareness of unconscious bias and engage in continuous reflection on gender issues are essential to reducing gender disparity in academic institutions. A conceptual framework of the glass ceiling for women leaders will be applied, which posits that institutions that apply principles of justice to management policies are more effective in addressing gender disparities.24,25 Finally, the authors will use an intersectionality lens, which examines how multiple social identities intersect at the individual level and reflect social and structural systems of privilege and oppression, to encourage a deeper appreciation of the lived experience of inequity.15,26
An experienced librarian developed the search strategy for this review in consultation with content experts and methodologists, and a second librarian peer reviewed the MEDLINE search strategy using the Peer Review of Electronic Search Strategies (PRESS) checklist.27 The search strategy was developed in two steps. The initial scoping was conducted using MEDLINE and Embase to ensure appropriate terms were included, and then the strategy was translated for use in each database to be searched. The MEDLINE search strategy is included in Appendix I. Additional searches for gray literature will be guided by the Canadian Agency for Drugs and Technologies in Health (CADTH) Grey Matters checklist to identify potentially relevant sources.28 The third step of searching will include scanning the bibliographies of included articles and related systematic reviews, searching the Gender in Global Research group project folder established by Elsevier (a knowledge user on the project), and reviewing team members’ personal files.
Information sources include electronic databases (MEDLINE [Ovid], Embase [Ovid], PsycINFO [Ovid], CINAHL [Ovid], Web of Science, JBI Evidence-based Practice Database [Ovid], Cochrane and Evidence-Based Medicine Reviews Database, and Campbell Library Index), relevant gray literature websites (see examples in Appendix II), and web searches. The authors will also scan reference lists of included articles and relevant systematic reviews, and review sources provided by knowledge users and experts in the field.
In accordance with the Cochrane guidance on living reviews, the authors will re-run electronic database searches 12 months after the original search date to determine when to update the review.14 Monthly literature searches will be conducted, and the review will be updated when at least 10% new literature has amassed. If there is insufficient new literature to warrant an update, the authors will re-run the literature search monthly, again checking for at least 10% new citations compared to the original search results. At least one update is planned; however, the number of subsequent updates will depend on the availability of funding to complete the work.
Following completion of the search, all records were uploaded into EndNote X7 (Clarivate Analytics, PA, USA) for de-duplication. Screening forms will be prepared based on the eligibility criteria and pilot tested by the entire review team prior to level 1 (title/abstract) and level 2 (full-text) screening. The pilot tests will consist of 50 citations at level 1 and 20 full-text articles at level 2, and will be repeated until there is sufficient agreement (≥75%) among reviewers. For both levels, the remaining screening will be completed by two reviewers independently using the Knowledge Translation Program's proprietary screening software, Synthesi.SR (Knowledge Translation Program, St. Michael's Hospital, Toronto, Canada). Discrepancies between reviewers will be resolved by discussion or with a third reviewer. The results of the search and selection process will be summarized using a PRISMA flow diagram.19
Data will be collected using charting forms developed in consultation with the entire team, pilot tested using a sample of five to 10 full-text articles, and revised iteratively until suitable agreement is reached among reviewers. The authors will collect data on study characteristics (eg, publication type, study design), participant characteristics including intersectionality data on social identities (eg, age, race, class), discipline or field (eg, biomedical, clinical, health services), and outcomes (eg, gender representation in faculty/institutions). The authors will collect and report data related to participant characteristics that address aspects of social, sex, and gender identity as reported by the authors of research articles included in our review. Where available, data regarding the definitions of sex, gender, race, ethnicity, sexuality, indigenous status, or disability status will also be collected, as will descriptions of how these social identities intersect using the authors’ definitions. This information will be utilized to avoid incorporating erroneous assumptions into the data and will form part of the data to be presented in the review results. Full charting will be completed by two reviewers independently, and discrepancies between reviewers will be resolved by discussion or by a third reviewer.
Data analysis and presentation
The data collected from included studies will be summarized according to the types of populations, contexts, or outcomes that are the primary focus of their research. Quantitative outcome data will be synthesized using descriptive frequencies, tabulation, and other visual means of displaying data. Information from qualitative studies will be organized via descriptive qualitative content analysis that may employ simple coding structures informed by the theoretical model of gender bias in medicine and the conceptual framework of the glass ceiling. Where available, intersectionality data will be summarized and cross-tabulated with outcome data to provide a broader perspective on factors that influence gender equity, and specifically, the intersection of gender with other identities highlighted by the Tri-Agency Institutional Programs Secretariat's ACEDIP and the Dimensions Charter.10,12
Potential impact of this research
To date, there is little comprehensive mapping of the global evidence for gender inequity and its intersection with multiple social identities among academic institutions that conduct health research. A thorough understanding of how different identities, including gender, are represented in academic health research is needed to help develop interventions to address the issue and evaluate the impact of those interventions. This synthesis will serve as a guide to developing future research in the area of gender representation and provide a deeper examination into how intersecting identities can influence outcomes among individuals in academic institutions that conduct health research.
Dr. Santa Ono, Dr. Linda Rabeneck, Dr. Christine Allen, and Yvonne James for their contributions to the research proposal that formed the basis of this work. Sinit Michael and Navjot Mann for their assistance in formatting and preparing this manuscript for publication.
This project is funded by a CIHR Project Grant (grant #PJT-165927). The funder had no part in the design of this protocol. ACT is funded by a Tier 2 Canada Research Chair in Knowledge Synthesis; HOW is funded by a Fonds de recherche du Québec—Santé Research Scholar Junior 2 award. SES is funded by a Tier 1 Canada Research Chair in Knowledge Translation and Quality of Care, the Mary Trimmer Chair in Geriatric Medicine, and a Foundation Grant (Canadian Institutes of Health Research). IDG is a recipient of a CIHR Foundation Grant (FDN # 143237). ILB is the holder of a University Research Chair in Gender, Diversity and the Professions.
Appendix I: Search strategy
MEDLINE – Search date: October 31, 2019, Records retrieved: 18,403
Database: Ovid MEDLINE: Epub Ahead of Print, In-Process & Other Non-Indexed Citations, Ovid MEDLINE® Daily and Ovid MEDLINE® <1946-Present>
1 exp Gender Identity/
2 gender differences.mp.
3 (sex disparit∗ or sex difference?).mp.
4 gender identity.mp.
5 sex role.mp.
6 wom#n∗ role?.mp.
7 (man∗ role? or men∗ role?).mp.
8 gender∗ role?.mp.
11 (gender∗ adj5 (analys#s or authorship? or balance? or bias∗ or capacity-building or characteristic? or comparison? or composition? or difference? or discrepanc∗ or disparit∗ or discriminat∗ or distribut∗ or divers∗ or equal∗ or equit∗ or gap or gaps or harass∗ or imbalance? or inequalit∗ or inequit∗ or issue or issues or parity or proportion∗ or represent∗ or role or roles or stereotyp∗ or structure? or trend∗ or underrepresent∗ or under-represent∗ or variation?)).tw,kf.
12 ((female? or wom#n∗ or male or males or man or “man's” or men or “men's” or sex or sexual) adj3 (bias∗ or discriminat∗ or equal∗ or equit∗ or gap or gaps or harass∗ or inequalit∗ or inequit∗ or stereotyp∗ or represent∗ or underrepresent∗ or under-represent∗)).tw,kf.
13 ((female? or wom#n∗ or male or males or man or men) adj5 (investigator? or researcher? or scientist? or surgeon?)).tw,kf.
15 (sexism∗ or sexist?).tw,kf.
16 Dentists, Women/
17 Physicians, Women/
18 or/1-17 [GENDER FILTER]
19 exp “Academies and Institutes”/
20 exp Academic Medical Centers/
21 exp Education, Professional/
22 exp Faculty/
23 exp Schools, Health Occupations/
24 exp Universities/
25 exp Hospitals, Teaching/
26 ((hospital? or medical centre? or medical center? or health care centre? or health care center? or healthcare centre? or healthcare center? or science? centre? or science? center?) adj3 (educat∗ or teach∗ or train∗ or universit∗)).tw,kf.
27 (academe or academia∗ or academic∗ or dean or deans or faculty or faculties or professor∗ or scholar∗).tw,kf.
28 ((interim∗ or semester∗ or sessional) adj3 (instruct∗ or teach∗)).tw,kf.
29 ((health or healthcare or medical or medicine or dental or dentistry or nursing or nutrition or pathology or pharmacy or rehab or science?) adj3 (academy or academies or educat∗ or institut∗ or school? or universit∗)).tw,kf.
30 ((education∗ or research∗ or upper learning) adj3 (academic or academy or academies or institut∗ or universit∗)).tw,kf.
31 ((teaching or training) adj3 (academic or academy or center? or centre? or college? or hospital? or institut∗ or universit∗)).tw,kf.
32 ((medicine or medical) adj3 (department? or dept or depts)).tw,kf.
33 (allied health adj3 (department? or dept or depts)).tw,kf.
34 (audiology adj3 (department? or dept or depts)).tw,kf.
35 ((dentistry or dental) adj3 (department or dept or depts)).tw,kf.
36 (epidemiolog∗ adj3 (department or dept or depts)).tw,kf.
37 (nursing adj3 (department? or dept or depts)).tw,kf.
38 (nutrition adj3 (department? or dept or depts)).tw,kf.
39 (occupational therapy adj3 (department? or dept or depts)).tw,kf.
40 (pharmac∗ adj3 (department or dept or depts)).tw,kf.
41 (physiotherapy adj3 (department? or dept or depts)).tw,kf.
42 (physical therapy adj3 (department? or dept or depts)).tw,kf.
43 ((rehabilitation therapy or rehab therapy) adj3 (department? or dept or depts)).tw,kf.
44 (pathology adj3 (department? or dept or depts)).tw,kf.
45 (research adj3 (department? or dept or depts)).tw,kf.
46 (tenure∗ or non-tenure∗ or nontenure∗).tw,kf.
47 Research Personnel/
48 (research adj2 (personnel or staff or worker?)).tw,kf.
49 ((audiolog∗ or clinical or clinician? or dental or dentist∗ or dietition? or epidemiolog∗ or health or healthcare or health care or health science? or medical or nurs∗ or nutrition∗ or patholog∗ or pharmacist? or physician? or physiotherap∗ or psychologist? or STEMM or technologist? or therapist?) adj2 (researcher? or scientist?)).tw,kf.
50 exp “Awards and Prizes”/
51 Financing, Organized/
52 Research Support as Topic/
53 exp Training Support/
54 (award∗ or grant or grants or prize or prizes).tw,kf.
55 ((financial∗ or fund or funded or funding or funds or research or training∗) adj1 support∗).tw,kf.
56 (research adj3 (fund or funded or funding or funds)).tw,kf.
59 ((first or principal or senior or guarantor) adj author?).tw,kf.
60 (“Canadian Association of Professors of MEDICINE” or CAPM).tw,kf.
61 or/19-60 [ACADEMIA]
62 18 and 61 [GENDER AND ACADEMIA]
63 exp Animals/ not (exp Animals/ and Humans/)
64 62 not 63 [ANIMAL-ONLY REMOVED]
Appendix II: Potential gray literature sources
Canadian research organizations
- Canadian Institute for Health Information: www.cihi.ca
- Canadian Centre on Substance Use and Addiction: www.ccsa.ca
- Canadian Agency for Drugs and Technologies in Health: www.cadth.ca
- Canadian Foundation for Healthcare Improvement: www.cfhi-fcass.ca
- Canada Health Infoway: infoway-inforoute.ca
- Canadian Patient Safety Institute: www.patientsafetyinstitute.ca
- Canadian Partnership Against Cancer: www.partnershipagainstcancer.ca
- Mental Health Commission of Canada: www.mentalhealthcommission.ca
- National Research Council: nrc.canada.ca
- Social Sciences and Humanities Research Council: www.sshrc-crsh.gc.ca
- Canadian Institutes of Health Research: www.cihr-irsc.gc.ca
- Canadian Centre for Gender & Sexual Diversity: www.ccgsd-ccdgs.org
International research organizations
- Humboldt Foundation: www.humboldt-foundation.deInstitute of International Education: www.iie.org
- Karolinska Institutet: ki.se
- Pan-American Health Organization: www.paho.org
- Rand Corporation: www.rand.org
- World Health Organization – Global Health Workforce Network: www.who.int/hrh/network
Gender advocacy organizations
- Society for Canadian Women in Science and Technology: www.scwist.ca
- Science in Australia Gender Equity: www.sciencegenderequity.org.au
- UK Equality Challenge Unit – Athena SWAN Charter: www.ecu.ac.uk/equality-charters/athena-swan/
- Academic Women's Association, University of Alberta: uofaawa.wordpress.com
- American Medical Women's Association: www.amwa-doc.org
- Centre for Gender Advocacy: www.genderadvocacy.org
- European Gender Portal for Equality in Science: www.genderportal.eu
- ADVANCE: Increasing the Participation and Advancement of Women in Academic Science and Engineering Careers: www.colorado.edu/eer/research-areas/women-science
General gray literature sources
- Government of Canada: publications.gc.ca
- Grey Literature Report: www.greylit.org
- SIGLE (System for Information on Grey Literature in Europe [OpenGrey]): www.opengrey.eu
- U.S. Department of National Technical Information Service: www.ntis.gov
- TRIP database: www.tripdatabase.com
- Google: www.google.ca/advanced_search
- Google Scholar: scholar.google.com
- Center for Research Libraries, Foreign Dissertations: www.crl.edu
- DART-Europe E-theses Portal: www.dart-europe.eu
- Electronic Theses Online Service (EThOS), British Library: ethos.bl.uk
- Open Access Theses and Dissertations: https://oatd.org/
- Thesis Canada Portal: www.bac-lac.gc.ca
- Gender Summit: gender-summit.com
- Canadian Coalition of Women in Engineering, Science, Trades and Technology: www.ccwestt.org
- Association of Faculties of Medicine of Canada: afmc.ca
- Association of American Medical Colleges: www.aamc.org
- U15, Group of Canadian Research Universities: www.u15.ca
- University of Toronto Gender Equity Report: faculty.utoronto.ca/reports/gender-equity-report
- Institute for Gender and the Economy, at the Rotman School of Management (University of Toronto): www.gendereconomy.org
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