OBJECTIVE: Recent studies have reported gender differences in research grant applications and funding outcomes for medical school faculty. Our goal was to determine whether similar patterns exist at the resident level and, if so, to explore possible explanations.
METHODS: We conducted a retrospective review of all applications to an internal, mentored research grant fund at a large academic pediatric residency program from 2003 to 2008. We determined whether gender differences existed for application characteristics and outcomes and defined significant predictors of success.
RESULTS: During the 5-year period, the fund supported 42 (66%) of 64 applications. Among all applicants, men were more likely than women to hold an advanced research degree. Men requested more money than women and obtained more favorable application scores. Funding success rates were not statistically different between male and female applicants. Among funded applicants, men received higher awards than women, although the percentage of requests funded was the same. In a multiple regression analysis, advanced degree was the significant independent predictor of successful funding outcome. Controlling for advanced degree attenuated the association between gender and timing of application, type of project, dollars requested, and dollars awarded; however, even after controlling for advanced degree, women had inferior grant scores compared with men.
CONCLUSIONS: Gender differences existed in research grant applications and funding among pediatric residents that mirrored faculty patterns. Among residents, these differences were explained in part by the correlation of male gender with holding an advanced research degree.
Recent studies have highlighted significant gender disparities in medical research funding. In 2005, the National Institutes of Health (NIH) reported that the average dollar value of awards to women was 20% lower than awards to men.1 Similarly, a recent study of gender differences in grant applications and funding outcomes across institutions at Harvard Medical School showed that female faculty members, particularly at the lowest ranks, submitted fewer grant applications overall (and to the NIH in particular) than men.2 In both studies, women faculty requested less support and received less funding, although the percentage of requested funding received was similar to men. Obtaining adequate research funding is an important element of successful advancement and may be both causative and reflective of the slow advancement of women to professorial ranks in academic medicine.3–7 With increasing numbers of women choosing a career in pediatrics, gender disparities in grant funding are likely to have a significant impact on the scientific progress of the field.
Because these gender differences in grant funding have been noted by both the NIH and Harvard faculty, we undertook this study to determine whether similar patterns already exist at the residency level. We investigated applications to an internal mentored research grant program for pediatric residents. We studied the characteristics of applications to this fund to determine whether gender differences exist in research grant applications and funding outcomes and, if so, to explore possible explanations for the disparity.
We conducted a retrospective review of all grant applications submitted by pediatric residents from the Boston Combined Residency Program to the Frederick H. Lovejoy, Jr Research and Education Fund for each academic year 2003–2004 through 2007–2008.8 The “Lovejoy Fund” was established as a hospital-invested endowment fund in 2003 to support resident research in the basic and clinical sciences as well as in health services and education.9 During the period of study, individual project grants of up to $5000 were awarded on an annual basis. Applications included a 2-page project proposal with references, budget justification, curriculum vitae, and a letter of support from the sponsoring mentor. A group of 10 established researchers who represented basic, clinical, health services, and medical education research reviewed and scored each application. Scoring followed an NIH format, with 4 established metrics: significance and relevance, approach, innovation, and feasibility. Scores ranged from 1 (outstanding) to 5 (acceptable). Two reviewers independently read and scored each application, then submitted the scores to the entire committee. The full committee discussed each application and reached consensus on an overall score. Funds were awarded consecutively only on the basis of the relative ranking of the applicant's score and on total dollars available in the fund each year ($30000–$50000 annually during the period of study).
For all residents in the Boston Combined Residency Program from 2003 through 2008 (n = 327), we collected data on gender, holding an advanced research degree (PhD or MPH), academic career plans, and application for a Lovejoy grant (n = 65). Subspecialty fellowship and general pediatrics faculty positions were considered to be academic career plans; private practice and alternative plans such as travel were not. For each of these variables, we compared residents who applied for a mentored grant with those who did not apply. Analysis of career plans was restricted to graduates who had embarked on their next position (n = 231).
The 65 grant applicants together filed 64 applications, accounting for group applications and multiple applications. There were 5 group applications; all of these applicants had the same degree status, career plan, and postgraduate level, and only 1 was mixed gender. We coded this application as female, according to the gender of the individual designated as the lead investigator. Six individuals each submitted 2 separate applications for different projects.
From the 64 applications filed to the Lovejoy fund, we obtained additional data on variables hypothesized to be related to gender and/or funding success. These variables were type of project proposed (clinical/educational/health services or basic research), the year of residency (1–4) during which the application was filed, mentor gender and academic rank, size of grant request, application score, and whether the application was funded.
For successful applicants (n = 42), we also noted size of grant awarded and percentage of request funded. We compared applicants who received funding with unfunded applicants to determine significant predictors of success and explored the interactions between gender and factors that influenced grant success.
We examined the associations between categorical variables using Fisher's exact tests for 2 dichotomous variables and Pearson χ2 tests for variables with ≥3 categories. To examine subgroup differences for continuous outcomes that were skewed, such as dollar amounts and score, we used the Mann-Whitney-Wilcoxon 2-sample test of association. We conducted logistic regression analyses to determine independent predictors of binary outcomes such as applying for funding and successful funding. Using analysis of covariance, we assessed the influence of gender on selected continuous intermediate outcomes of interest. These outcomes had skewed distributions; therefore, we natural log–transformed the data for analyses. We calculated geometric means as the inverse of the means of the natural log–transformed data. We considered a 2-sided P < .05 to be statistically significant. The Children's Hospital Boston institutional review board approved this study.
Characteristics of Residents and Applicants to the Lovejoy Fund
During the study period, 327 residents were enrolled in the residency program and therefore eligible to apply for Lovejoy funding. Two thirds of all residents were female. Twenty-one percent had an advanced research degree (PhD or MPH), and men were nearly twice as likely to have an advanced degree compared with women (31% vs 16%; P = .004). Among the 231 residents who had completed residency by 2008, 72% had entered academic fellowships or an academic career, and this did not differ by gender (77% [men] vs 70% [women]; P = .28).
Sixty-five residents submitted applications to the Lovejoy Fund. Men and women were equally likely to apply to the Lovejoy Fund: 21% of male and 19% of female residents applied for funding (P = .77). Twenty-three percent of residents with an advanced degree (MPH or PhD) applied for funding, compared with 19% of applicants without an advanced degree (P = .50). Of the residents who ultimately pursued academic careers, 28% applied for funding, compared with only l4% of residents who chose not to pursue an academic career (P = .03).
Comparison of Applications to the Lovejoy Fund by Gender
During the study period, of 64 applications to the Lovejoy fund, 61% were from women and 39% were from men (Table 1). Several differences existed between male and female applicants. Male applicants were more likely to hold an MPH or a PhD compared with women (48% vs 18%; P = .01) and were more likely than women to apply early for funding in year 1 or 2 of their residency training (64% vs 33%; P = .02). Men requested more money than women (median $5000 vs $3350; P = .03) and were more likely to achieve a fundable score (median: 2.05 vs 2.66; P = .003). There was a trend toward men's proposing more basic science projects than women (24% vs 5%; P = .08). Women were more likely to propose a clinical, health services, advocacy, or education project. There were no significant differences between genders in career plan, mentor gender, or mentor rank.
In an analysis of covariance (for continuous variables) and a logistic regression analysis (for binary variables) of variables and outcomes associated with gender, controlling for advanced degree significantly attenuated the association between gender and year of application, type of project, dollars requested, and dollars awarded (data not shown); however, even after controlling for advanced degree, women had less favorable grant scores than men (adjusted geometric mean score: 2.45 vs 1.98; P = .04).
Characteristics of Successful Applications to the Lovejoy Fund
During the study period, the Lovejoy Fund provided grants to 42 (66%) resident projects of 64 applications (Table 2). Men were successful at obtaining a grant 76% of the time, compared with 59% for their female counterparts (P = .19). Of successful applicants, men received more money than women (median: $5000 vs $3000; P = .02). The median percentage of requests funded was the same (both 100%; P = .60). Successful applicants were more likely to hold an advanced research degree (95% vs 53%; P = .001) and to have a mentor with rank above instructor (78% vs 43%; P = .02). Applicant gender, career plans, postgraduate level of application, gender of mentor, and type of project were not significantly associated with success in obtaining a grant. In a multiple logistic regression analysis that controlled for applicant gender, advanced degree, and mentor rank, the primary predictor of success at obtaining a Lovejoy grant was whether the applicant had an MPH or a PhD (adjusted odds ratio: 11.40 [95% confidence interval: 1.33–97.70]).
Our study found that even at the early career stage of pediatric residency, female grant applicants differed from their male peers. Differences between male and female applicants included previous training, timing of application, and grant request dollar amount; there were outcomes differences in both score and funds awarded. These differences paralleled gender disparities noted in a previous study of Harvard Medical School grants, which showed that although success rates were similar between men and women after controlling for faculty rank, women submitted fewer grants earlier in their careers, requested less money, and were granted correspondingly lower awards.2
Several hypotheses attempt to explain gender differences in grant behavior and funding at the faculty level. These include decreased interest in research among women compared with teaching and patient care, more focus on personal life, inadequate mentorship for women, institutional bias in structural supports for female researchers, lower salary levels for women faculty, and behavioral differences between men and women2,10–12; however, many of these barriers are not applicable to residents. Pediatric residents are unlike faculty in that they are not allocated institutional research support by the department chair or division chief and there is no variability in current compensation. Residents also have a standard mix of clinical, teaching, and research time built into their job.
Given the similarities in the systemic supports for male and female residents, it seems that characteristics of the individuals themselves have greater influence on their grant behavior and outcomes. In particular, women used a different grant strategy; they were also less likely to have an advanced research degree. These individual-based features could explain the downstream differences in application score and amount awarded.
One feature common to the resident and faculty groups is that men tended to apply for research grant monies earlier in their career. It may be that the men (both trainee and junior faculty) are more confident in their research interests and are simply more attuned to opportunities to gain research skills, to obtain funding, to establish mentorship relationships, and to devise workable projects earlier. Previous studies suggested that among medical school graduates, women are significantly less likely than men to indicate strong research career intentions.13,14 This “late-bloomer” effect may persist into residency and beyond, perhaps heightened by differential mentorship.
Given the documented importance of mentorship in research development and productivity,15 different use and success of mentorship relationships are often cited as impediments to women's success.4,7,16–18 Our study represented only a cross-sectional view of early career mentorship; however, it is interesting to note that successful applications were more likely supported by faculty holding a rank of assistant professor or higher. Although not statistically significant, women tended to choose female mentors at the instructor level, compared with men, who chose male mentors at higher rank. This may reflect in part the distribution of female faculty at our institution, where 65% of female faculty members are at instructor rank. A larger study would be needed to determine whether these relationships are borne out and whether same-gender mentorship and “role-modeling” improved success or rather perpetuated adverse gender-based grant behaviors.
Another “individual-based” difference noted between male and female researchers at both the faculty and resident levels is that women asked for less money. There is evidence in the social science literature to support the idea that the variability of grant requests by gender can be explained by differences in perceptions, interaction styles, and negotiation tactics.19–21 Specifically, in structured interviews of women and men in the midst of salary negotiations, women are noted to feel more unsure of their worth and to feel less entitled to payment than men.21 In turn, male evaluators tend to view negatively women who initiate negotiations as overly demanding and not “nice” without similarly stigmatizing or penalizing men.22 Years of internalizing this subtle societal bias may lead women to minimize their initial budget requests. Although the Lovejoy grants are not salary requests per se, it is possible that similar attitudes (conscious or not) about the worth of the proposed project, deservedness as a researcher, or fear of being personally viewed unfavorably might have influenced budget proposals of female applicants. In our small sample, the presence of an advanced degree mitigated any effect of gender-based behavioral differences.
The success of applicants with advanced degrees likely reflected in part the process of obtaining an MPH or a PhD, which requires exposure to grant-writing, mentorship from people who have successfully obtained grants and conducted research, and previous personal experience with completing a research project. Applicants with such experience have more advanced skills in creating a project proposal and may be perceived by granting committees as being more likely to see a project through to completion. Such applicants would then be more likely to achieve better scores and funding outcomes. The improved success of applicants with research degrees mirrors statistics from the NIH and other institutions.23,24
What is less clear is why our female applicants—and our female residents overall—were less likely than their male counterparts to hold an advanced research degree. Although we cannot exclude selection bias in our single-institution study, national trends show the number of women lagging among MD-PhD students.25 The combined MD-PhD degree in particular may be less attractive to women, who fear that the length of training may preclude combining career and family life, who learn of gender disparities in remuneration and promotion, or who simply lack female role models.12
Our analysis suggests that efforts to correct such disparities should focus on addressing individual exposures and skills at the premedical, medical school, graduate medical training (resident and fellow), and faculty levels. Comparing matriculating and graduating medical student self-reports of interest in scientific research suggests that interest expands with exposure.26 In addition, positive attitudes about research and publishing research before completing residency are predictors of entry into academic medicine and of a high level of productivity at the faculty level.27,28 This indicates that encouraging positive research experiences for students and trainees may help solidify interest and commitment to academic careers. Educators may note that the Lovejoy Research and Education Fund, by promoting positive research experiences, may in the long run actually help to correct the disparities that it currently predicts. Although a causal relationship cannot be concluded from our data, our study does indicate that Lovejoy applicants are more likely than nonapplicants to pursue an academic career.
It may also be that some elements of the advanced degree experience could be successfully replicated in briefer versions in medical school, residency, and beyond to offer some of the same benefits. These elements might include grant writing and “grantsmanship” workshops, improved education in research methods, and structured mentorship programs for undergraduate and graduate researchers. Of note, the Howard Hughes Medical Institute's one-year, nondegree research training programs seem to have had success both at attracting women and at achieving goals of postdoctoral support and faculty appointment similar to their advanced degree students.29 Such programs can be incorporated within the structure of pediatric residency.9
Our study has several limitations. First, we cannot fully account for competing funding sources that would have drawn applicants away from the Lovejoy pool or influenced funding requests. For example, it may be that some residents conducted research projects in well-funded faculty laboratories and therefore felt no need to apply for additional grants. Our experience suggests that well-funded mentors encourage residents to apply for any funding available. There are other internal and external sources for resident research grants; however, residents can apply to more than 1 funding source. Given the high success rate and ample funding of the Lovejoy program, we believe that it is unlikely that resident researchers would not have applied for funding. The small sample size limited our power to detect statistically significant differences between genders and to explore further the interactions between gender and advanced degree. Because the study was conducted at a single institution, its generalizability may be limited and suggests a need to look at other pediatric programs and also at national residency competitions for grants. Future research should continue to assess gender differences in grant applications and outcomes in broader populations and to explore why these differences exist and possible corrective factors.
Grant funding is an important element of productivity and advancement in academic medicine. The pipeline of academic pediatricians is largely female, with women composing 70% of current pediatric residents.30 It is therefore important to the future of pediatric research that we continue to investigate gender disparities in grant funding and further explore intervention programs to address the issues identified.
Gender differences existed in research grant proposals and funding among pediatric residents and mirrored gender disparities previously noted in faculty studies. Specifically, women applied later in training, requested and received less money, and had unfavorable application scores compared with men. Among our residents, these differences were explained largely by the correlation of male gender with holding an advanced research degree. The advanced degrees likely represented enhanced research skills and mentoring. For residents without previous research experience or advanced degrees, specific mentoring or coursework may improve grant-writing and funding success rates and may address gender disparities earlier in the careers of future academic pediatric faculty.
We acknowledge Janet Shahood, Elayne Fournier, and Barbara Roach for assistance in data collection and in the administration of the Frederick H. Lovejoy, Jr, MD, Research and Education Fund.
- Accepted March 12, 2009.
- Address correspondence to Mary Beth Gordon, MD, Children's Hospital Boston, Department of Medicine, Main 9S Room 9156, 300 Longwood Ave, Boston, MA 02115. E-mail:
Financial Disclosure: The authors have indicated they have no financial relationships relevant to this article to disclose.
What's Known on This Subject:
Recent studies of medical school faculty at Harvard and at the NIH highlight gender disparities in research grant applications. These disparities include timing and number of grants submitted, amount requested, and amount awarded.
What This Study Adds:
This study demonstrates that gender differences in research grant applications and outcomes already exist during residency. By examining characteristics of applicants, we explore reasons for the disparities and suggest avenues for correction.
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