ABSTRACT
Introduction Women make up the majority of medical school students in most high-income countries. Despite this, women remain underrepresented in senior academic leadership positions including editorial boards of mainstream biomedical journals. Many studies show the underrepresentation of women in mainstream medical journals; however, gender representation in medical student journals (MSJs) is not well documented. Assessing diversity and inclusion in MSJs is vital to understanding the point at which biases in academic medicine are established. Understanding when biases in medical authorship manifest may allow for a more targeted approach to alleviating these biases. This study explores diversity in MSJs by examining gender representation on editorial boards, geographic region, and socioeconomic status of the country of origin. Methodology In November 2019, Google©, Yahoo!, and Bing search engines as well as PubMed and Google Scholar databases were searched for English-language MSJs using standardized criteria. The websites of identified journals were screened and relevant journal and editorial board-related data were collected. The gender of board members was determined using a sequential approach. Results A total of 21 MSJs were included with over half (n = 12, 57.1%) established during the last decade (median years of operation = 9, range = 3-97 years). Most MSJs (n = 17, 81%) are based in North America and Europe. All but one (published in an upper-middle-income country) of the 19 journals originating from a specific country are published in high-income countries. Of the total 348 board members identified (33 editors-in-chief and 315 other editors), 169 were women (48.6%) and 179 were men (51.4%). Women occupied 48.5% of editor-in-chief positions and 48.6% of other editorial board roles. Conclusions The gender gap in medical journal leadership appears early during medical education and continues to widen after joining the workforce. Geographic and socioeconomic disparities present in mainstream medical journals also extend to MSJs. Future research should seek to determine whether gender bias is also seen in medical student authorship across MSJs. Approaches to minimizing gender gaps in medical journal leadership should target current medical students as the biases begin to manifest during this period of their education.
ABSTRACT
Introduction Telepsychiatry is becoming an increasingly appealing option for mental health treatment due to its ability to overcome barriers which prevent certain demographics from having access to mental health services. There is a surprising lack of research being done on this promising mode of health care delivery. The aim of this study is to evaluate the existing literature in order to determine the clinical effectiveness and cost-effectiveness of telepsychiatry in resource-constrained environments. Methods Literature searches were performed in PsychINFO, PubMed, Medline, EMBASE, Centre for Reviews and Dissemination, and the Cochrane Library Controlled Trial Registry databases (2000 - May 2017). A search of the following terms was used: telemedicine; telemedical; telepsychiatry; telepsychiatric; teleconsultation; e-health; video conference; and telecare. Type of mental disorder and intervention, along with the clinical outcome or patient satisfaction, were all identified. Exclusion criteria included studies with a sample size of fewer than 10 cases, as well as studies which failed to analyze intervention outcomes. Results Of the 1,477 identified articles, 14 randomized controlled trials were included for review. Despite the methodological limitations and the small number of existing studies, there appears to be limited evidence pointing towards the efficacy of telepsychiatry in resource-constrained environments, although patients and providers tend to prefer face-to-face treatment over video conferencing. Two of the studies included in this paper found video conferencing to be more effective than face-to-face treatment, while none reported the opposite. At the very least, we hypothesize that psychotherapeutic treatment delivered via video conferencing is just as effective as a traditional treatment, albeit less desirable. Conclusion More research is required in order to further evaluate the efficacy of telepsychiatry in the management of mental illness, as there is a current lack of scientific evidence to draw any conclusions. However, there exists a strong hypothesis that telepsychiatric treatment yields the same results as the traditional, in-person therapy and that telepsychiatry is a useful alternative when traditional therapy is not possible. Countries with substantial numbers of refugees living in resource-constrained areas, such as camps, should be encouraged to develop telepsychiatry programs.
