Gender equality in academic medicine before, during and after COVID: what have we learned? A systematic review.

Abstract Background Gender disparity at senior levels in academic medicine has been recognised for decades, but progress has been slow and confounded further by the COVID pandemic. While there are many papers describing this problem, there is little evidence for potential solutions. We aimed to describe the current evidence for interventions to enhance gender equality in academic medicine, and to compare interventions pre, during and post-COVID-19. We also wished to characterise the nature of the interventions, who delivered them, and whether they seek to “fix the women”, or target issues at organisational and systemic levels. Methods We searched five electronic databases in November 2022 and August 2023 and undertook hand-searching. We extracted data using a form developed for the study, and applied the TIDieR and Morahan frameworks to describe and characterise interventions. We used the QUADs tool to critically appraise included studies. Results The search of electronic databases yielded 1,747 studies. A further 62 were identified through hand-searching. Following removal of duplicates, 764 articles were screened for eligibility, and 199 full-text articles were screened. Of these, 27 met the inclusion criteria. The most commonly reported interventions were career development or leadership skills programmes, followed by mentorship and multi-faceted interventions. Most papers reported positive findings, but many relied on subjective measures. Robustly designed studies often reported mixed findings. The majority of interventions aimed to “fix the women”, with few addressing inequality at organisational level. We found no studies describing interventions aimed specifically at mitigating the effects of the COVID pandemic, and none describing the effects of the pandemic on their interventions. Conclusion Acknowledging the possibility of publication delay, we found that despite strong evidence of the negative effects of the pandemic on women’s research productivity, there were no new interventions designed to mitigate this. Many existing interventions create “institutional housekeeping” by relying on women for their delivery, this can result in failure, especially during a crisis like COVID. Most studies were low to moderate quality. More robust research, and a more holistic approach is needed, moving away from “fixing the women” to address the organisational and systemic structures which underpin inequality.