LAUSR

To the Editor, The concept of a pipeline has emerged as one pathway to increase diversity in science, technology, engineering, and mathematics. Barriers to gain access to this pipeline are being mitigated, and yet the number of women continues to decrease as levels of education, training, and promotion increase. Similar to Mannix et al.,1 we undertook determining how the promotion of women to chief resident compared their representation in emergency medicine (EM) residencies. The published study and ours used similar outreach to contact programs to identify chief resident gender. We varied in our inclusion of programs and the additional details we collected. Mannix et al. surveyed all ACGMEaccredited programs and we also included AOAaccredited EM programs. In addition to collecting data for the thencurrent year (2018– 2019) we collected longitudinal data, included geographic regions, whether the program was community or academic center based, and the presence of intentional efforts to recruit women to leadership. Our chief resident data included from academic year 2013– 2014 through 2018– 2019. Over this period of time, there was no significant shift in proportions of chief residents based on gender. Percentages ranged from a low of 31.9% in 2016– 2017 to a high of 40.6% in 2018– 2019. Assessment of length of program mirrored the results from Mannix et al.— there was no difference in the rates of female chiefs for all years. Threeyear programs ranged from 32% to 40.5%, and 4year programs ranged from 31.2% to 40.9%. There was no association between geographic location and percentage of women residents, chiefs, or faculty. As we evaluate the underrepresentation of women in higherechelon leadership positions, we must consider how women advance professionally and at what rate. While it is reassuring that in EM we have gender parity at the chief resident level, this trend of equity does not continue throughout a woman's career. In 2005– 2007, the Society for Academic Emergency Medicine (SAEM) convened a taskforce focused on the advancement of women in EM and published their findings in 2008. At that time, the percentage of female residents in EM was 35.5% and was cited as an opportunity for improvement. The recommendations from the taskforce included action items for national professional organizations, medical school deans, department chairs, and female faculty and aimed to bring awareness to the disparities in career advancement.2 The percentage of female residents at the time the taskforce was convened is similar to the 34.4% of female applicants to EM residencies in 2018– 2019.3 While female faculty and leaders had slight increases in representation (18% of professors, 30% of associate professors, 39.5% of assistant professors, 46.7% of instructors) the percentage of women residents remained flat.4 Our study was limited by sample size, with a 41% response rate. While this is typical for surveybased studies,5 Mannix et al. achieved an excellent response rate of 82%. Another limitation was that we did not obtain historical numbers of female faculty or residents, only chiefs. This may have created some blind spots with regard to the potential associations between representation in those areas and as chief.