Women and academic careers in obstetrics and gynaecology: aspirations and obstacles among postgraduate trainees - a mixed-methods study
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DOI: 10.1111/1471-0528.15574 General obstetrics
www.bjog.org
Women and academic careers in obstetrics and
gynaecology: aspirations and obstacles among
postgraduate trainees – a mixed-methods study
L Berlingo,a,b A Girault,a,b,c E Azria,b,c,d,e F Goffinet,a,b,c C Le Raya,b,c
a
Port Royal Maternity Unit, Cochin Hospital, Assistance Publique-H^ opitaux de Paris, DHU Risks in Pregnancy, Paris, France b Paris
c
Descartes University, Paris, France Inserm UMR 1153, Obstetrical, Perinatal and Paediatric Epidemiology Research Team (EPOPe), Centre
for Epidemiology and Statistics Sorbonne Paris Cite (CRESS), Paris-Descartes University, Paris, France d Maternity Unit Notre Dame de Bon
Secours, Paris Saint Joseph Hospital, Paris, France e DHU Risks in Pregnancy, Paris, France
Correspondence: L Berlingo, Maternite de Port Royal, Hopital Cochin, 123 boulevard du Port Royal, 75014 Paris, France.
Email: laura.berlingo@gmail.com
Accepted 2 November 2018. Published Online 6 February 2019.
Objective To examine the relationship between gender and a identified the following obstacles: persistent gender
career in academic medicine. stereotypes that produce everyday sexism, lack of
identification with male role models, lack of mentors,
Design Mixed-methods study.
perceived discrimination, an ideal of professional excellence
Setting Obstetrics–gynaecology postgraduate training programme that is difficult to attain, constraining professional
in Paris, France. organisational norms, inequality between men and women
in the domestic and family spheres, and finally self-
Sample Postgraduate trainees in obstetrics–gynaecology (n = 204).
censorship and important doubts about their ability to
Methods Statistical analysis of quantitative survey data, thematic combine a demanding career and a fulfilling personal life.
analysis of qualitative interview data and integrative analysis.
Conclusions Women reported the desire to follow a career in
Main outcome measures Women’s aspirations and obstacles academic medicine half as often as men. Improving the presence
related to their decision about a career in academic medicine. and visibility of role models for residents and combating
Results A career in academic medicine was envisaged by 13% workplace discrimination will address some of the barriers to
of the women residents and 27% of the men (P = 0.01). women choosing a career in academic medicine.
Women reported receiving advice from a mentor less often
Keywords Academic career, gender, medicine, mixed methods,
than men (38.8% versus 52.9%, P = 0.002). Overall, 40.6%
obstetrics and gynaecology, qualitative research, residency,
of women and 2.9% of men reported experiencing gender
women.
discrimination (P < 0.001). In response to the question ‘Do
you have doubts about your ability to pursue or succeed at Tweetable abstract Women obstetric trainees in France are only
an academic career?’, 62.4% of the women and only 17.7% half as likely as men to envisage following an academic path.
of the men answered yes (P < 0.001). The global analysis
Please cite this paper as: Berlingo L, Girault A, Azria E, Goffinet F, Le Ray C. Women and academic careers in obstetrics and gynaecology: aspirations and
obstacles among postgraduate trainees – a mixed-methods study. BJOG 2019;126:770–777.
women comprise only around 14% of academic physi-
Introduction
cians in the same specialty.
Although the number of women practising medicine Edmunds et al.13 analysed 52 articles on this subject in a
today continues to grow, women remain underrepre- narrative review published in The Lancet in April 2016.
sented in academic careers, regardless of their spe- Hypotheses repeatedly proposed to explain the lower per-
cialty.1–8 The field of obstetrics and gynaecology is no centage of women in academic medical careers in the dif-
exception to this.9–12 In Paris, 84% of the current post- ferent studies included: women might be more interested
graduate trainees in this specialty are women but in teaching than in research, they experience gender
770 ª 2018 Royal College of Obstetricians and GynaecologistsWomen and academic careers
discrimination, or they lack mentors. Some of the studies Qualitative analysis
reviewed concluded that women may be less interested in From this broad sample, we chose to interview only those
research than men, or that they turn away from academic women postgraduate trainees who were ambivalent about
careers for financial reasons, although other studies did not their career choice; that is, those who either said that they
identify a gender difference for these reasons.1 wanted an academic career but doubted they could have
Because of the many and time-consuming prerequisites one, or said they did not want an academic career but had
for an academic career (a master of science, a PhD, a taken or planned all the prerequisite career steps (master of
mobility period of 12 months and international publica- science, PhD, mobility, publications). Our goal was to
tions), most of the residents choosing to pursue this path understand why women who effectively could have an aca-
do so during their first years of residency. demic career hesitated to proceed.
The objective of our study, conducted among a popula- Interviews were conducted by telephone between July
tion of current obstetrics–gynaecology postgraduate trainees 2017 and January 2018. LB obtained oral consent from all
in Paris, was to assess the existence of differences between participants before the interviews. A flexible, semi-struc-
women and men at the moment of their choice of an aca- tured topic guide was used to facilitate women’s descrip-
demic career and, if any were found, to identify the factors tions of their personal experiences. Interviews were
that keep women from seeking this type of career. recorded, fully transcribed, anonymised and identified by a
number (e.g. P1 = participant 1).
Data were analysed by applying ‘grounded theory’, with
Methods
thematic analysis, after repeated readings by LB and discus-
A mixed-methods design was devised to examine the aspira- sions with CLR (the principal study investigator). The first
tions of obstetrics–gynaecology postgraduate trainees in Paris stage was primary coding, to identify the themes and sub-
and any obstacles to accessing academic careers encountered themes from the raw data. These categories were then
by the women in the population. The Paris area was chosen themselves analysed to examine their properties and their
because it is the largest in terms of trainee numbers and interconnections. These data were then conceptualised to
because, in this area, trainees have a mailing list and weekly reach an explanatory theory.
courses ensuring a satisfactory response rate. The analysis began with the first interview and was mod-
ified and expanded with each new one. We stopped at eight
Quantitative analysis participants when we determined that we had reached data
We performed a cross-sectional survey among postgraduate saturation, that is when further interviews provided no new
trainees in obstetrics and gynaecology in Paris. A question- elements to the analysis.14
naire was circulated to all of them (n = 309), first via the The interviewer was LB, a woman and postgraduate trai-
internet (three reminders between May 2016 and February nee who might have inspired trust and empathy with the
2017) then in a paper version directly during a weekly course. interviewed women. LB was as objective as possible in
We developed this questionnaire using previous interna- the analysis of the data, and all authors contributed to the
tional studies3–7,13 to collect several types of data: social analytical process.
and demographic characteristics, career aspirations includ-
ing research and teaching, the importance of different pri-
Results
orities in life (including, but not limited to, leisure, family
and earnings) and potential obstacles to an academic Sample characteristics
career. The first question asked respondents to state their Among the 309 postgraduate trainees in obstetrics–gynae-
gender: male or female. The survey was first tested on five cology in Paris, 204 (66%) completed the questionnaire,
residents then circulated to all the trainees. including 170 women (83.3%) and 34 men (16.7%).
Our principal analysis for each question compared men Table 1 presents their social and demographic characteris-
and women. We then compared the data about obstacles to tics, according to gender. When comparing men and
accessing an academic career for the men and women in women, we found no significant differences in their age,
the subgroup of ‘academic aspirants’ (those who stated that year of residency, relationship status or family situation.
they wanted a career in academic medicine). Participants We conducted eight interviews with a mean duration of
were not aware of this plan to compare them by gender. 43 minutes 36 seconds (minimum 33 minutes 59 seconds,
We used STATA software, version 12.0 (College Station, maximum 49 minutes 09 seconds). The mean age of the
TX, USA), for the statistical analyses, applying chi-square women was 28.4 years and they had on average completed
and Fisher’s exact tests to compare the discrete variables, 80% of their fourth year (of five) of residency. Six lived
and Student’s t test and nonparametric tests to compare with a partner, and three had children. Seven had already
the continuous variables. completed, started or planned for the next year a research
ª 2018 Royal College of Obstetricians and Gynaecologists 771Berlingo et al.
visiting post. We found no significant differences between
Table 1. Social and demographic data, and career aspirations,
analysis by gender men and women for any of these prerequisites. Overall, 73.7%
(n = 146) of the postgraduate trainees wanted or planned a
Women Men P fellowship; this response differed significantly between the
(n = 170) (n = 34)
groups (70.7% for women compared with 88.2% for men,
n (%) n (%)
P = 0.035). We found no difference between them in their
Mean SD Mean SD
desire to teach or carry out research. When they were asked
what type of career they planned, the women most often
Age 27.1 2.0 26.8 2.2 0.49
Year of 2.9 1.6 2.6 1.6 0.45
answered that they expected to be hospital staff physicians
residency (1–5) (61.3% versus 33.3% among men, P = 0.01). The men most
No partner 50 (29.4) 8 (23.5) 0.56 frequently responded that they would be in private practice
Academic partner 25 (21) 4 (15.4) 0.72 (39.4% versus 25.6% among women) or academic medicine
Support from 113 (94.2) 21 (80.8) 0.02 (27.3% versus 13.1%, respectively; P = 0.01; Table 1).
partner
No children 150 (88.2) 30 (90.9) 0.67
Obstacles identified
Father: 19 (11.2) 2 (5.9) 0.35
academic
Mother: 32 (18.8) 5 (14.7) 0.57 Residency in a world of male professors
academic Women reported having a mentor less often than men
Master of 90 (52.9) 19 (57.6) 0.63 (38.8% versus 52.9% of the men, P = 0.002). The differ-
science: ences in perceived gender discrimination were stark: 40.6%
completed for women and 2.9% of the men reported experiencing
or desired
gender discrimination (P < 0.001). Role models did not
PhD in science: 23 (13.6) 5 (14.7) 0.86
completed or
appear to differ: women reported having role models as
desired often as men did (Table 3).
At least one 95 (55.6) 18 (52.9) 0.75 The qualitative component of the study, however,
publication enabled us to interpret the process of identification in more
Mobility 88 (51.8) 15 (44.1) 0.42 detail (Table 4). Women did have role models, but for the
period: most part they did not identify with them. They were too
completed or
perfect, so that the postgraduate trainees did not think
desired
Postresidency 116 (70.7) 30 (88.2) 0.03
themselves able to equal them, or they were too discon-
fellowship nected from real life or too ‘crazy’, so that resembling them
Wants to do 28 (16.5) 10 (29.4) 0.15 did not appear desirable. Some women interpreted the per-
research petual dominance of men in academic careers in this light:
Wants to teach 88 (51.8) 23 (67.7) 0.17 male postgraduate trainees, because they see male aca-
Career demics throughout their residency, may find such a career
envisioned
normal and so ask themselves fewer questions about its fea-
Private practice 43 (25.6) 13 (39.4) 0.01
Academic medicine 22 (13.1) 9 (27.3)
sibility. The postgraduate trainees interviewed all agreed
Hospital staff physician 103 (61.3) 11 (33.3) about the importance of a mentor for success in an aca-
demic career and were astonished by the political nature of
appointments and the importance of a network. They very
master’s degree, six had plans for a post as assistant chief rarely had a mentor. The discrimination reported here by
resident and three were considering a doctoral dissertation women was essentially linked to time periods of pregnancy
in science. Five reported that they were hesitant about an and maternity leave, which neither their supervisors nor
academic career, two said they wanted one but were doubt- their fellow postgraduate trainees eyed favourably. They
ful and one had the prerequisites for it but said she did often described experiencing gender prejudice and everyday
not want it. sexism concerning their abilities and their involvement in
pursuing a time-consuming academic career.
Aspirations of obstetrics–gynaecology postgraduate
trainees ‘Building a family’: a difficult balance
Among all respondents, 53.7% (n = 118) had or planned to Table 2 summarises life priorities by gender. The women
complete a master’s degree and 13.7% (n = 28) a PhD. More accorded more importance than the men to their family life
than half (55.4%, n = 113) had already published an article, and to flexibility of working hours. Otherwise, we found no
and slightly more than half (50.5%, n = 103) had planned a statistically significant difference between them (Table 2).
772 ª 2018 Royal College of Obstetricians and GynaecologistsWomen and academic careers
the same as for the total population: 54.6% (n = 12) of
Table 2. Priorities, analysis by gender. Question asked: ‘For the
following elements, please rank from 1 (least important) to 5 (most the women doubted their ability to pursue or succeed in
important) their importance for your future self-fulfilment?’ an academic career, while no men did (P = 0.004)
(Table 3). All of them held high standards about what
Women (n = 170) Men (n = 34) P
constitutes a good academic doctor (Table 4). They found
Median (25–75) Median (25–75)
the three distinct facets of this profession – teaching,
research and clinical practice – desirable, despite the sub-
Family life 5 (4–5) 4.5 (4–5) 0.02
stantial amount of time and energy it demands. For them,
Leisure 4 (3–4) 4 (3–5) 0.99
Flexibility of 4 (3–4) 3.5 (3–4) 0.04 an academic doctor has a true vocation, one that requires
work schedule a strong commitment. The profession is noble, but in the
Earnings 4 (3–4) 4 (3–4) 0.21 end does not appear realistic to them. They affirmed sev-
Social recognition 3 (2–4) 3 (3–4) 0.87 eral times that ‘normal’ human beings cannot do every-
Interest of the 4 (4–5) 4 (4–5) 0.97 thing, or at least cannot do everything well. Only 38% of
professional
the entire group considered that it was possible to recon-
activity
cile all three aspects of academic medicine (Table 3). It
Intellectual 4 (4–4) 4 (4–5) 0.79
stimulation appeared difficult for these women to identify themselves
Transmission of 3 (3–4) 4 (3–4) 0.53 with these people they perceived as ‘superior’, and they
knowledge were amazed at the great self-confidence of the male post-
graduate trainees, revealed in the quantitative study. It
finally appeared that, contrary to what the quantitative
study suggested, their doubts about their ability to pursue
It is important not to misinterpret these women’s state- a career in academic medicine were not related to ques-
ments about their family life (Table 4). The value of work tions about their intellectual abilities but rather about their
is fundamental for them – providing self-fulfilment and capacity to commit themselves as much as they considered
empowerment. They did not want to ‘choose their family necessary to attain this ideal of a ‘good academic doctor’,
life over career’ or, as one woman said, ‘become a house- with the multiple skills it requires and the multiple duties
wife’; instead they wanted public and institutional policies it imposes. Moreover, from a perspective less personal than
(hospital and university) to allow them to link both work institutional and societal, they wondered about the organi-
and family. A decision about parenthood in the lives of sational norms: presenteeism, schedule flexibility and
these women, at the age (globally, between 25 and remote work (telework).
35 years) where they must take decisions about their career
and its future, appears destabilising. Beyond the practical
questions associated with planning pregnancy and mater-
Discussion
nity leave, they wondered how to balance their new status Main findings
as mothers with the schedule of a resident with academic During their residency men and women do not appear to
aspirations. This issue raised questions for many of them. envisage the same eventual career. Despite identical initial
They were well aware that men were finding parenthood training, and although women met the prerequisites for an
less disruptive than they did. All of those with ‘helpful’ academic career as often as men, women planned for an
partners considered themselves lucky. They considered it academic career less often and had greater doubts about
impossible to succeed without this support. their ability to succeed.
Triangulation of the results of the questionnaire and the
Wanting to be an academic physician: between idealising interviews identified numerous obstacles for women:
the profession and doubting one’s own abilities enduring gender stereotypes that subject women to ‘ordi-
Our results show that men and women accorded equal nary sexism’, lack of identification with mostly male role
levels of importance to interest in their professional activ- models, a lack of mentors, a difficult-to-attain ideal of
ity, intellectual stimulation and the transmission of knowl- excellence in all the profession’s components (clinical,
edge. They reported similar levels of interest in research teaching, research and management), stronger self-censor-
and in teaching (Table 2). When asked ‘Do you have ship and doubts about their ability to pursue this type of
doubts about your ability to pursue/succeed at an academic career than among men, organisational norms for academic
career?’, 62.4% (n = 106) of the women answered ‘yes’ careers that are still quite male-oriented and not especially
compared with only 17.7% (n = 6) of the men (P < 0.001) compatible with women’s ‘real lives’ and their aspiration to
(Table 3). The results in the subgroup with ‘academic aspi- balance their personal and working lives, perceived discrim-
rations’ (n = 31, 22 women and 9 men) were essentially ination (especially concerning maternity leave), and the
ª 2018 Royal College of Obstetricians and Gynaecologists 773Berlingo et al.
Table 3. Potential obstacles to an academic career, in the total population and among those with academic aspirations, analysis by gender
Total sample Among those with
academic aspirations
Women Men P Women Men P
(n = 170) (n = 34) (n = 22) (n = 9)
n (%) n (%) n (%) n (%)
Do you get advice from an academic physician about your future career? Yes 66 (38.8) 18 (52.9) 0.002 13 (59.1) 9 (100) 0.07
Do you feel you are supported when you work on a research project? Yes 62 (36.5) 12 (35.3) 0.89 13 (59.1) 5 (55.6) 1
Do you think that it’s possible to reconcile (in terms of time) research activity, 62 (36.7) 15 (44.1) 0.67 11 (50) 8 (88.9) 0.17
teaching and clinical practice? Yes
Among the academic doctors on staff who you know, would you say that 116 (68.2) 20 (58.8) 0.18 19 (86.4) 6 (66.7) 0.14
some are models for you? Yes
If yes, are they mainly the same sex as you? Yes 60 (51.7) 11 (55) 0.79 10 (52.6) 2 (33.3) 0.65
Have you already experienced discrimination or prejudice due to your gender? Yes 69 (40.6) 1 (2.9)Women and academic careers
Table 4. Qualitative data by theme: excerpts from interviews
Theme Subtheme Sample extracts from interviews
Women postgraduate trainees in ‘Ordinary sexism’ P3: ‘When you say you are going to specialise: “oh really, that’s not
a world of male professors too hard for a woman?” [. . .]
P5: ‘I had a department head, a guy, who said “in any case, you’ll
end by doing ART, you’ll finish at 4 pm, and then you’ll make brats.”
Since I was married, that was it.’
Lack of identification with P1: ‘After all, you have to be a little bit crazy to have a
models, lack of mentor career in academic medicine.’
P5: ‘The people we could currently consider as mentors are the
university professors, and they are almost all men. I did not deal
with any woman professors during my residency. . . . I think that the
life choices aren’t exactly the same. There is still some ingrained
difference between men and women, and it’s always
related to children’
Discrimination during pregnancy P4: ‘I felt discrimination, because when I started to talk about being chief
resident, he was clearly interested in my personal situation, with whether
or not I might have a baby during that period.’
P6: ‘It’s a little complicated to announce [maternity leave]. I didn’t get
any comments. Now I know that if I want a third child, I should wait
until the end of the chief residency.’
Building a family: a Fulfilment through work P2: ‘I don’t see myself ever stopping work to take care of the house
difficult balance and the children. It’s out of the question.’
P4: ’I could never stop working. My work also has to bring me
self-fulfilment, that’s essential for me.’
Parenthood as destabilising P3: ‘After, yes, it’s sure, having a child changes lots of things.’
P7: ‘The fact that this period [of becoming an academic physician]
for a woman – it happens at a moment where often she’s 30 years old,
she’s been living with a partner for a long time, she wants children,
it’s certainly complicated.’
Partner: support or brake P1:’ I know that my husband will be fairly helpful in this situation.
I’m lucky to have someone who is very very modern.
So it’s also a little easier with that.’
P4: ‘It’s important for me to have someone really
understanding with me.’
Wanting to be an A good academic doctor – very P1: ‘Medical school professors are finally people totally dedicated to
academic physician: demanding standards their profession.’
between idealising the P8: ‘First, they must be good clinicians. . . . And then people who
profession and self-criticism can teach well, there, who have expertise in pedagogy. And next
to that, they have to be researchers, who must know how to keep
up with all the innovations, so they have to read an enormous
number of scientific publications and have the skills to do their own
articles, and before publishing, they have to know how to do research.
It’s someone who must be pretty versatile.’
Do everything at once and do P3: ‘You cannot simultaneously do research, and teach, and see
everything well: impossible? patients. Well, you can’t have it all.’
P5: ‘You’re really torn, you always feel pulled by all of the things
you have to do and, truly, I wonder if it’s not outdated today because
you necessarily have to get to a point of not doing something or not
doing it as well as if you only had it to do.’
Doubt and self-criticism P4: ‘When you are a woman, and you still don’t have a child, but you
envision a family life, you envision really having a balanced life, really
giving time to your children, and you are working on your profession,
you’re climbing, you’re climbing, you say: “Am I going to succeed in
doing it all?” At some point, I will have to choose, because I am too
afraid of sacrificing my personal life.’
ª 2018 Royal College of Obstetricians and Gynaecologists 775Berlingo et al.
Table 4. (Continued)
Theme Subtheme Sample extracts from interviews
P5: ‘They doubt their ability to have at the same time a family life, and
an academic career. . . Are they going to be able, as women, to be able
to do all of that at the same time?’
Institutional norms P2: ‘If things were organised differently, perhaps we could
combine personal life and hospital life better.[. . .] ‘The structures,
the global frameworks would have to be better adapted to a life
that is not invested 100% in the hospital’. ‘Perhaps if more people
did it, the work could be better distributed, we would do all three,
but less intensely.’
P8: ‘I think that if we solved the problem, generally, of presenteeism
at the hospital, that could be a not-bad start.’
women have more doubts, not about their intellectual abilities Does the medical profession, or indeed society, allow a
but about the possibility of ‘having it all’: a brilliant career combination of family life and working life? Here, we need to
and a fulfilling family life – their real aspiration. Men and rethink the organisational norms of the profession, the modes
women put equal value on the interest of their professional of organising maternity leave, paternity leave, flexible working
work, intellectual stimulation and transmission of knowl- and telework. Moreover, all of those with ‘helpful’ partners
edge – all values associated with an academic career.15,22 In considered themselves lucky. It is more than a semantic point
2010, Borges et al.20 published a meta-analysis looking at to note that the term ‘helpful’ presupposes that it is normal
‘how, when and why’ physicians choose an academic career. for woman to be principally responsible for managing daily
Their results, like ours, showed no gender difference in the life. A little more than a decade ago, Robelet et al.30 showed
desire for the intellectual challenge associated with such a that doctors do not escape from the ‘classic’ distribution of
career. Contrary to the review by Edmunds et al.13 published tasks between men and women, with the mental burden of
in 2016, which found women to be more interested in teach- this organisation falling almost entirely on women. Educa-
ing than research, the men and women in our study reported tion, gender-linked social representations, mental burden,
equal interest in these two aspects of academic medicine, child care and management, housework – these issues are all
although family life and flexibility of the work schedule evidence of the absence of gender equality. As long as women
seemed slightly more important to the women in our study remain on the front line in the domestic sphere, they will have
than to the men. Other studies point in the same direction little chance of shattering the ‘glass ceiling’.
and underline that the work–life balance seems to be at the
heart of women’s concerns, perhaps more so than for men.6,12
Conclusion
Many of the postgraduate trainees we questioned want more
‘free time’ outside their work, a desire that reflects a general Among French obstetrics–gynaecology postgraduate trainees,
trend among young physicians. Robelet et al.30 reached this women aspire half as often as men to a career in academic
conclusion after 23 interviews with doctors younger than medicine. From the beginning of their residency, women
35 years, all of whom – men and women – distanced them- seem to hold themselves back, being less likely to affirm their
selves from the classic professional work ethic and wanted to desire to go into academic medicine even when they have all
set limits on the time spent working. the necessary qualifications. Lack of role models and men-
Our results suggest that further steps are needed to tors, gender discrimination, everyday sexism, a difficult-to-
attract more women to careers in academic medicine, reach standard of professional excellence, constraining pro-
beginning from the earliest days at medical school, to fessional organisational norms, inequality between men and
encourage and reassure them about the legitimacy of this women at home, and finally self-censorship and substantial
career aspiration. But this is not enough. Women’s con- doubts about their ability to simultaneously have a demand-
cerns about their ability to ‘accomplish everything at once’ ing career and a fulfilling personal life seem to be some of
are legitimate. In our study, fewer than half of the post- the obstacles that limit women’s access to academic careers.
graduate trainees considered it possible to find the time for Among other solutions, improving the presence and visibility
all three aspects of academic medicine, and this did not of role models for residents and combating workplace dis-
differ between genders. Reconsideration of this threefold crimination should address some of the barriers to women
combination of work might be useful. choosing a career in academic medicine.
776 ª 2018 Royal College of Obstetricians and GynaecologistsWomen and academic careers
Disclosure of interests 11 Hofler L, Hacker MR, Dodge LE, Ricciotti HA. Subspecialty and
gender of obstetrics and gynecology faculty in department-based
None declared. Completed disclosure of interests form
leadership roles. Obstet Gynecol 2015;125:471–6.
available to view online as supporting information. 12 Seltzer VL. Changes and challenges for women in academic
obstetrics and gynecology. Am J Obstet Gynecol 1999;180:837–48.
Contribution to authorship 13 Edmunds LD, Ovseiko PV, Shepperd S, Greenhalgh T, Frith P,
LB and CLR devised the study and the paper. CLR per- Roberts NW, et al. Why do women choose or reject careers in
formed the quantitative analysis and LB performed the academic medicine? A narrative review of empirical evidence. Lancet
2016;388:2948–58.
qualitative analysis. LB wrote the first draft. All authors
14 Dey I. Grounding grounded theory: guidelines for qualitative inquiry.
(LB, CLR, AG, EA and FG) contributed to interpretation San Diego, CA: Academic Press, 1999.
of the data by commenting on successive drafts, and 15 Straus SE, Straus C, Tzanetos K, International Campaign to Revitalise
approved the final version. Academic Medicine. Career choice in academic medicine: systematic
review. J Gen Intern Med 2006;21:1222–9.
Details of ethics approval 16 Borges NJ, Grover AC, Navarro AM, Raque-Bogdan TL, Elton C.
International women physicians’ perspectives on choosing an
The questionnaire was submitted to the National Data Pro-
academic medicine career. Perspect Med Educ 2013;2:156–61.
tection Authority (CNIL) (declaration number 1970557, 20 17 Borges NJ, Navarro AM, Grover AC. Women physicians: choosing a
June 2016), which approved it. career in academic medicine. Acad Med 2012;87:105–14.
18 Kupfer DJ, Schatzberg AF, Dunn LO, Schneider AK, Moore TL,
Funding DeRosier M. Career development institute with enhanced
mentoring: a revisit. Acad Psychiatry 2016;40:424–8.
No funding needed. &
19 Bickel J. Women in academic medicine. J Am Med Womens Assoc
(1972) 2000;55:10–2, 19.
20 Borges NJ, Navarro AM, Grover A, Hoban JD. How, when, and why
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