May 2023 Issue
​​ISSN 2689-291X

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Women in Cardiology:
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What Makes Them Special!

A Fellow-In-Training Perspective

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Introduction:
The field of Cardiology has advanced in all aspects of diagnosing, treating, and preventing cardiovascular disease; however, it still lags in one critical aspect: Underrepresentation of Women in Cardiology [1]. The Women in Cardiology (WIC) committee created by American Heart Association (AHA) and the American College of Cardiology (ACC) has helped in achieving success to obtain leadership opportunities, career advancement and professional growth to a great extent over the past 3 decades [2]. There are multiple challenges faced by women in this field dominated by men [3], especially during the fellowship training and in early years of career. Although 51% of medical school graduates [4] and 43% of internal medicine residents [5] are women, only 21% of cardiology fellows are women and only 13% of women are practicing cardiologists [6]. Additionally, there is suboptimal visibility of women in role of research publications [7], editorial boards of major journals, department chairs and in procedural subspecialities [8]. This underrepresentation can cause low self-esteem, lack of self-confidence, feelings of isolation, and eventually leading to burnout and professional exhaustion [9]. For fellows in training (FIT), gender-based assumptions can affect their evaluation thus inadvertently impacting opportunities for career advancement and recognition [10]. Fellowship training can be rigorously demanding, especially for women who wishes to balance their professional commitments with family responsibilities [11]. It is crucial to spread awareness about gender disparity between men and women and emphasize the need to take action to empower and elevate the women in cardiology [12]. It is important to address the challenges of gender inequity in recruitment and retention [13]. As FIT, it is important for you to recognize the existential crisis and know that you are not alone. We all need to create an inclusive and equitable environment for women in cardiology by formulating a strategic plan to address the issues and foster a supportive environment for both current and future female cardiologists [14].
 
Strategies for FIT to advocate for Women in Cardiology:

1. Mentorship: Fellows must be given an opportunity to choose their mentors and attend mentorship programs to connect with the seasoned professionals to help them navigate through challenges, create an action plan, obtain career advice, learn about work-life balance and personal development [15].
2. Networking: Fellows must be encouraged to participate in regional/national conferences, local chapter meetings, and join forums to connect with their peers, mentors, and role models. This can help them build social-skills, advocacy, project collaboration, sharing of innovative ideas and growth [16].
3. Social Media: social media has a strong impact in networking, mentoring and advancement opportunities in medicine [17]. ACC - FIT made it easier for trainees to connect with each other and follow prominent cardiologists on Twitter. It allows women to learn by virtually joining conferences if unable to attend in person. The AHA and the ACC have multiple online programs for women in cardiology providing mentorship, networking, and recruitment opportunities, however many women are not aware of these programs. WIC group on Facebook creates an outlet for addressing important issues to women, such as pregnancy, burnout, and barriers to work-life balance. This offers women a safe place to express and connect with peers.
4. Leadership opportunity: Training programs should create a pathway for women to assume leadership roles [18]. Participating in FIT editorial boards, writing committees and network forums can help gain national recognition. Fellows should participate in local and national meetings to present their research work and give lectures for further recognition.
5. Education: Institutions should be proactive in promoting diversity and inclusivity. Fellows should be encouraged to have an open conversation about gender issues, participate in WIC section meetings, reduce implicit bias, thus create a more welcoming environment for fellows. Female fellows should be invigorated to advocate for themselves, voice their concerns, and negotiate for opportunities that align with their career goals.
6. Recognition: Fellows are striving to do their best despite having an arduous journey. Acknowledging the work and outstanding contributions from female fellows can motivate them for further engagement and advancement.
7. Equal Opportunities: Fellows must be provided with equal opportunities for research projects, leadership roles, allocations of resources, and participating in events.
8. Parental support: Especially for women who might be juggling career aspirations with family responsibilities, it is imperative to provide flexible work schedule, adequate parental leave, lactation facilities and on-site childcare to help them manage both their professional and parental responsibilities effectively.
9. Data collection: ACC WIC has created 3 professional-life surveys to assess gender-based professional advancement, satisfaction, burnout, discrimination, harassment, compensation, mental health, leadership opportunities to collect and report data on gender disparities and elucidate gender-based inequalities.
10. Research Training: It is cardinal for fellowship training to offer opportunities to female fellows to participate in clinical trials, research, and publications to reduce gender disparities.

 
The Importance of Representation:

1. Enhanced Patient Care: Gender diversity can bring varied perspectives to patient care and diverse perspectives can lead to a better understanding of patient’s needs, women’s health, and enhances patient outcomes.
2. Research Advancement: Embracing gender diversity can strengthen innovation in research with a broader spectrum of ideas and insights, leading to a more comprehensive understanding of cardiovascular health [19].
3. Inspiring Future Generations: Visible women role models in cardiology can inspire young women and encourage them to pursue career in the field and achieve success, fostering a pipeline of diverse talent [20].

 
Conclusion:
Aspiring female cardiology fellows face unique challenges within this field grappling with gender disparities. Acknowledging these issues and implementing target strategies is necessary to create a supportive and inclusive training environment. By encouraging mentorship, advocacy, equitable evaluation, work-life balance, research opportunities, and dismantling implicit biases, the cardiology community can ensure that talented women are empowered to contribute their expertise, passion, and insights to advance the field and improve patient outcomes. As FIT, you should no longer be a witness to the challenges faced by women in cardiology, but you must embrace this opportunity to shape the future of diversity in cardiology. The time for transformation is now- let us seize the opportunity to empower women in cardiology and usher in a new era of excellence and innovation.
  
References:

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13. Lau ES, Wood MJ. How do we attract and retain women in cardiology? Clin Cardiol. 2018 Feb;41(2):264-268.
14. Sharma G, Lewis S, Singh T, Mehta LS, Mieres J, Poppas A, Harrington R, Piña IL, Volgman AS, Aggarwal NR. The Pivotal Role of Women in Cardiology Sections in Medical Organizations: From Leadership Training to Personal Enrichment. CJC Open. 2021 Aug 2;3(12 Suppl):S95-S101. 
15. Loethen J, Ananthamurugan M. Women in Medicine: The Quest for Mentorship. Mo Med. 2021 May-Jun;118(3):182-184. 
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17. Patel H, Volgman AS. Women in Cardiology: Role of Social Media in Advocacy. Curr Cardiol Rev. 2021;17(2):144-149.
18. Khan MS, Usman MS, Siddiqi TJ, Ayub MT, Fatima K, Acob C, Muhammad H, Manning WJ, Tsao C, Khosa F, Figueredo V. Women in Leadership Positions in Academic Cardiology: A Study of Program Directors and Division Chiefs. J Womens Health (Larchmt). 2019 Feb;28(2):225-232.
19. Pöss J, Ahrens I. Women in cardiovascular clinical trial leadership. Eur Heart J Acute Cardiovasc Care. 2023 Apr 3;12(3):211-212.
    
20. Eshtehardi P, Bullock-Palmer RP, Bravo-Jaimes K, Bozkurt B, Dorbala S, Gillam LD, Grines CL, Mehran R, Mieres JH, Singh T, Wenger NK. Women leaders: transforming the culture in cardiology. Open Heart. 2022 Feb;9(1):e001967. doi: 10.1136/openhrt-2022-001967

Authors:
Nupur Shah, M.D.
Cardiology Fellow
University of South Alabama
Mobile, AL

Bassam Omar, M.D., Ph.D.
Professor of Cardiology
University of South Alabama
Mobile, AL