Introduction
Global surgery has emerged as a critical academic and clinical field aimed at strengthening health systems worldwide and addressing disparities in access to surgical care, particularly in underserved regions [1–3]. Achieving universal health coverage and equitable surgical access requires strategies that integrate advocacy, capacity building, sustainable interventions, and gender‑inclusive frameworks within surgical systems [4]. Gender equity in leadership and representation is essential to ensure that policies and practices reflect the diverse populations they are intended to serve [5].
Despite growing advocacy, women and professionals from low‑ and middle‑income countries (LMICs) remain underrepresented in the academic discourse on global surgery [6]. Initiatives such as the Gender Equity Initiative in Global Surgery (GEIGS) were developed to promote equity through deliberate inclusion of underrepresented groups, including consideration of gender, geography, and professional status [7, 8]. The GEIGS General Assembly (GA) is an annual international meeting conducted virtually with a focus on amplifying the voices of women and professionals from LMICs [9].
This study examines speaker representation at the GEIGS GAs from 2020 to 2025, with attention to gender, geographic distribution, academic credentials, leadership roles, and specialty representation. By evaluating trends in representation and academic involvement, the study aims to identify strategies that may promote equitable participation and provide a framework for mentorship, leadership development, and inclusive program design in global surgery.
Materials and Methods
Study design and setting
A cross‑sectional study was conducted to analyze data from all invited guest speakers at the GEIGS GA from 2020 to 2025. The 2022 GA was excluded because the event was not held that year. This study was reviewed and approved by the University of Tennessee Medical Center Institutional Review Board, and the requirement for informed consent was waived because the study involved minimal risk and used de‑identified data.
Data collection
Data were retrospectively collected from GEIGS records and publicly available sources. Variables included gender, specialty, country of practice, highest degree earned, number of citations, prior conference experience, and presentation topics. Gender was self‑reported and extracted from anonymized GA data. Countries were classified as high‑income or low/middle‑income based on the 2024–2025 World Bank classification [10].
Statistical analysis
Descriptive statistics summarized variables across the five assemblies. Categorical variables were expressed as frequencies and percentages, and continuous variables as medians with interquartile ranges. Linear regression analyzed gender representation and credential differences between HIC and LMIC speakers. Mann–Whitney U tests compared citation counts between the two groups. Statistical significance was set at p < 0.05. Data were organized in Microsoft Excel and analyzed using STATA (version 18.0).
Results
During the study period, 104 speakers participated in the GEIGS GA. In 2020, there were a total 22 speakers (21.2%), followed by 19 speakers (18.3%) in 2021, 21 speakers (20.2%) in 2023, 24 speakers (23.1%) in 2024, and 18 speakers (17.3%) in 2025. Overall, females comprised 83.7% (n = 87/104) of the speakers (p < 0.001; β = 14.0; 95% CI [10.49–17.41]). In 2020, 86.4% (n = 19/22) of the speakers were women, followed by 73.7% (n = 14/19) in 2021, 90.5% (n = 19/21) in 2023, 87.5% (n = 21/24) in 2024, and 77.8% (n = 14/18) in 2025.
Speakers’ credentials
Overall, speakers holding a leadership position comprised 64.4% (n = 67/104). Speakers with multiple degrees were 36.5% (n = 38/104). The most common academic degree was an MD (n = 65/104, 62.5%), followed by PhD (n = 17/104, 16.4%) and masters’ degree (n = 5/104, 4.8%). Medical students accounted for 15.4% (n = 16/104). The speakers who had previous experience presenting at other events were 73.1% (n = 76/104). The overall median of speakers’ research citation numbers was 116 with the interquartile range [0–599] (Table 1).
Table 1
Speakers’ characteristics.
| GENERAL ASSEMBLY YEAR | ||||||
|---|---|---|---|---|---|---|
| 2020 | 2021 | 2023 | 2024 | 2025 | Total | |
| Number of speakers n, (%) | 22 (21.2) | 19 (18.3) | 21 (20.2) | 24 (23.1) | 18 (17.3) | 104 |
| Female speakers, n (%) | 19 (86.4) | 14 (73.7) | 19 (90.5) | 21 (87.5) | 18 (17.3) | 87 (83.7) |
| Speakers with leadership positions, n (%) | 14 (63.6) | 9 (47.4) | 11 (52.4) | 20 (83.3) | 13 (72.2) | 67 (64.4) |
| Speakers with multiple degrees, n (%) | 4 (18.8) | 9 (47.4) | 10 (47.6) | 10 (41.7) | 5 (27.8) | 38 (36.5) |
| MD as a higher degree, n (%) | 10 (45.4) | 15 (78.9) | 12 (57.1) | 15 (62.5) | 13 (72.2) | 65 (62.5) |
| PhD as a higher degree, n (%) | 1 (4.5) | 4 (21.1) | 5 (23.8) | 5 (20.80) | 2 (11.1) | 17 (16.4) |
| Masters as a higher degree, n (%) | 1 (4.5) | 0 (0) | 0 (0) | 3 (12.5) | 1 (5.6) | 5 (4.8) |
| Medical students, n (%) | 10 (45.4) | 0 (0) | 4 (19.0) | 1 (4.2) | 1 (5.6) | 16 (15.4) |
| HIC speakers, n (%) | 15 (68.2) | 8 (42.1) | 15 (71.4) | 13 (54.2) | 12 (66.7) | 63 (60.6) |
| LMIC speakers, n (%) | 7 (31.8) | 11 (57.9) | 6 (28.6) | 11 (45.8) | 6 (33.3) | 41 (39.4) |
[i] Note: Table 1 describes the characteristics of the speakers across the five editions of the GEIGS General Assembly (2020–2025). HIC, high‑income countries; LMIC, low‑ and middle‑income countries.
Speakers’ country of practice
The overall majority of speakers (n = 63/104, 60.6%) practiced in HICs, while 39.4% (n = 41/104) were from LMICs (p = 0.117; β = 4.4; 95% CI [–1.721, 10.521]) (Table 1). The countries representing HIC were the United Kingdom, United States, Switzerland, Sweden, Canada, Italy, Poland, Ireland, Kuwait, and Australia. The countries representing LMICs were Argentina, Brazil, Egypt, Ethiopia, Ghana, India, Kenya, Lebanon, Somalia, Malaysia, Mexico, Nigeria, Pakistan, Rwanda, South Africa, Zambia, Zimbabwe, and Venezuela (Figure 1).
Figure 1
Speakers’ country of practice.
Note: Figure 1 illustrates the geographic distribution of GEIGS General Assembly speakers by country, categorized by high‑income countries (HICs) and low‑ and middle‑income countries (LMICs). Created with Datawrapper.
Of the speakers practicing in LMICs, 82.9% (n = 34/41) were females, 65.9% (n = 27/41) had leadership positions, 34.1% (n = 14/41) possessed multiple academic degrees, and 68.3% (n = 28/41) had previously spoken at other events. The most common highest degrees were MD (n = 25/41, 61.0%) and PhD (n = 9/41, 22.0%). Medical students represented 12.2% (n = 5/41). The median number of research citations was 53 [0–410]. Regarding HIC speakers, 84.1% (n = 53/63) were women, 63.5% (n = 40/63) had leadership positions, 38.1% (n = 24/63) had multiple academic degrees, and 77.8% (n = 49/63) had previously spoken at other events. MD (n = 40/63, 63.5%) and PhD (n = 8/63, 12.7%) were the most common highest degrees. Speakers who were medical students comprised 17.5% (n = 11/63). The median of research citation numbers was 253 [45–753]. There were no significant differences in speaker credentials between HIC and LMIC (p > 0.05) (Table 2).
Table 2
Credentials of speakers in LMICs vs HICs.
| HIC (N = 63) | LMIC (N = 41) | P‑VALUE | β; [95% CI] | |
|---|---|---|---|---|
| Female speakers, n (%) | 53 (84.1) | 34 (82.9) | 0.087 | 0.085; [–0.016 – 0.185] |
| Speakers with leadership positions, n (%) | 40 (63.5) | 27 (65.9) | 0.142 | 0.095; [–0.040 – 0.230] |
| Speakers with multiple degrees, n (%) | 24 (38.1) | 14 (34.2) | 0.161 | 0.114; [–0.056 – 0.286] |
| MD as a higher degree, n (%) | 40 (63.5) | 25 (61.0) | 0.060 | 3.00; [–0.166 – 6.166] |
| PhD as a higher degree, n (%) | 8 (12.7) | 9 (22.0) | 0.828 | –0.031; [–0.351 – 0.289] |
| Medical students, n (%) | 11 (17.5) | 5 (12.2) | 0.389 | 0.078; [–0.119 – 0.276] |
| Speakers who have previously spoken at conferences, n (%) | 49 (77.8) | 28 (68.3) | 0.160 | 4.20; [–2.566 – 10.966] |
| Citation median [IQR] | 253 [45–753] | 53 [0–410] | 0.342* | — |
[i] Note: Table 2 presents an overall comparison of speaker credentials between high‑income countries (HICs) and low and middle‑income countries (LMICs). β is the coefficient of the linear regression analysis; 95% CI is the confidence interval.
[ii] *The p‑value of citation median was generated from a Mann–Whitney U test.
Speakers’ specialty
The speakers’ medical specialties that had an overall higher frequency were obstetrics and gynecology with 10.6% (n = 11/104) of speakers, followed by global surgery (n = 8/104, 7.7%), neurosurgery (n = 8/104, 7.7%), trauma surgery (n = 7/104, 6.7%), pediatric surgery (n = 6/104, 5.8%), general surgery (n = 6/104, 5.8%), and public health specialists (n = 6/104, 5.8%). The specialties with the lowest frequencies were anesthesiology, transplant surgery, otorhinolaryngology, and pediatrics, each representing 0.9% (n = 1/104). These were followed by global health (n = 2/104, 1.9%), surgical oncology (n = 2/104, 1.9%), urology surgery (n = 2/104, 1.9%), bariatric surgery (n = 2/104, 1.9%), vascular surgery (n = 2/104, 1.9%), orthopedic surgery (n = 3/104, 2.9%), internal medicine n = 3/104, 2.9%), thoracic surgery (n = 4/104, 3.8%), plastic and reconstructive surgery (n = 5/104, 4.8%), and endocrine surgery (n = 5/104, 4.8%) (Table 3).
Table 3
Speakers’ professional specialties.
| SPEAKERS’ PROFESSIONAL SPECIALTY, N (%) | 2020 (N = 22) | 2021 (N = 19) | 2023 (N = 21) | 2024 (N = 24) | 2025 (N = 18) | TOTAL (N = 104) |
|---|---|---|---|---|---|---|
| Obstetrics and gynecology | 1 (4.5) | 1 (5.3) | 3 (14.3) | 3 (12.5) | 3 (16.7) | 11 (10.6) |
| Global surgery | 2 (9.1) | 0 (0) | 2 (9.5) | 1 (4.2) | 3 (16.7) | 8 (7.7) |
| Neurosurgery | 2 (9.1) | 2 (10.5) | 1 (4.7) | 1 (4.2) | 2 (11.1) | 8 (7.7) |
| Trauma surgery | 2 (9.1) | 3 (15.8) | 1 (4.7) | 0 (0) | 1 (5.6) | 7 (6.7) |
| Pediatric surgery | 0 (0) | 3 (15.8) | 0 (0) | 3 (12.5) | 0 (0) | 6 (5.8) |
| General surgery | 0 (0) | 2 (10.5) | 2 (9.5) | 2 (8.3) | 0 (0) | 6 (5.8) |
| Public health | 0 (0) | 0 (0) | 3 (14.3) | 2 (8.3) | 1 (5.6) | 6 (5.8) |
| Endocrine surgery | 0 (0) | 2 (10.5) | 1 (4.7) | 2 (8.3) | 0 (0) | 5 (4.8) |
| Plastic and reconstructive surgery | 1 (4.5) | 1 (5.3) | 0 (0) | 2 (8.3) | 1 (5.6) | 5 (4.8) |
| Thoracic surgery | 1 (4.5) | 2 (10.5) | 0 (0) | 0 (0) | 1 (5.6) | 4 (3.8) |
| Internal medicine | 1 (4.5) | 2 (10.5) | 0 (0) | 0 (0) | 0 (0) | 3 (2.9) |
| Orthopedic surgery | 1 (4.5) | 0 (0) | 0 (0) | 2 (8.3) | 0 (0) | 3 (2.9) |
| Global health | 0 (0) | 0 (0) | 2 (9.5) | 0 (0) | 0 (0) | 2 (1.9) |
| Surgical oncology | 0 (0) | 0 (0) | 0 (0) | 2 (8.3) | 0 (0) | 2 (1.9) |
| Urology surgery | 0 (0) | 0 (0) | 1 (4.7) | 1 (4.2) | 0 (0) | 2 (1.9) |
| Bariatric surgery | 0 (0) | 0 (0) | 0 (0) | 0 (0) | 2 (11.1) | 2 (1.9) |
| Vascular surgery | 1 (4.5) | 0 (0) | 0 (0) | 0 (0) | 1 (5.6) | 2 (1.9) |
| Anesthesiology | 0 (0) | 1 (5.3) | 0 (0) | 0 (0) | 0 (0) | 1 (0.9) |
| Otorhinolaryngology | 0 (0) | 0 (0) | 0 (0) | 1 (4.2) | 0 (0) | 1 (0.9) |
| Pediatrics | 0 (0) | 0 (0) | 0 (0) | 1 (4.2) | 0 (0) | 1 (0.9) |
| Transplant surgery | 0 (0) | 0 (0) | 1 (4.7) | 0 (0) | 0 (0) | 1 (0.9) |
[i] Note: Table 3 outlines the distribution of speaker professional specialities across the GEIGS General Assemblies from 2020 to 2025.
General assembly session topics
A total of 56 sessions were held throughout the five editions of the GEIGS GA. The GA edition of 2023 had the highest number of sessions (n = 13/56, 23.2%), followed by 2024 and 2025 each representing 21.4% (n = 12/56). The 2021 GA edition had the fewest number of sessions (n = 9/56, 16.1%), followed by 2020 (n = 10/56, 17.9%). We grouped the session topics into seven main themes relevant to global surgery and gender equity. Overall, the most frequently discussed theme was Diversity, Gender Equity, and Inclusion (n = 17/56, 30.4%), followed by Advocacy, Policy, and Structural Change (n = 14/56, 25.0%), Research and Innovation (n = 7/56, 12.5%), Mentorship and Career Development (n = 6/56, 10.7%), Work‑Life Balance and Gender Expectations (n = 4/56, 7.1%), GEIGS Internal Insights (n = 4/56, 7.1%), and Regional Insights (n = 3/56, 5.4%). The specific session titles and yearly counts are described in Table 4.
Table 4
GA sessions and main themes.
| 2020 (N = 10) | 2021 (N = 9) | 2023 (N = 13) | 2024 (N = 12) | 2025 (N = 12) | TOTAL (N = 56) | |
|---|---|---|---|---|---|---|
| Main Themes | Session Title | |||||
| Diversity, Gender Equity, and Inclusion, n (%) | 2 (20.0) | 5 (55.6) | 2 (15.4) | 5 (41.7) | 3 (25.0) | 17 (30.4) |
| Intersectionality | Patient Preference on Their Physician Gender? How to Overcome It | The Urgent Need for Gender Affirming Care | Advancing Transgender Health Equity: A Call to Action | Education Without Borders: Collaborative Efforts for Inclusive and Quality Learning | ||
| Diversity, Equity, and Justice in Global Surgery | Male Allies—How Can Majority Identities Take Steps to Further Gender Equity | Women in Global Surgery Equity in Leadership | Advancing Gender Equity in Global Surgical Education | Gender Equity in Surgical Training and Workforce Development | ||
| Panel with Global Women Surgeon | Global Access to Gender Affirming Surgery and Transgender Care | From Representation to Transformation: Lived Experiences and Leadership in the Fight Against Inequality | ||||
| Intersectionality | Ensuring Gender Inclusive and Safe Spaces in Global Health Conferences | |||||
| Gender Inequities in COVID‑19 Leadership and How We May All “Build Back Better” | How Not to Make Diversity Equity and Inclusion a Checkbox Exercise | |||||
| Advocacy, Policy, and Structural Change, n (%) | 1 (10.0) | 2 (22.2) | 2 (15.4) | 4 (33.3) | 5 (41.7) | 14 (25.0) |
| Advocacy Session | Global Surgery the Current Landscape | Advocacy for Global Surgery Insights | How to Minimize Duplicating Efforts by Global Surgery Organizations | Empowerment Access and Sustainable Well‑Being | ||
| Advocacy Session | Insights on Climate Change and Global Health | Role of Gender in Countryside Surgical, Anesthesia, and Obstetric Plans and Policies | Advocacy in Gender Equity: Using Social Media to Build Community and Drive Change | |||
| Workplace Policies Guarantee Gender Equality in the Surgical Workforce | Saving Mothers, Saving Futures: Blood, Health, and Human Rights | |||||
| Empowering Change Through Allyship | Women Leading Climate Action in Surgery: A Path Toward SDG 13 | |||||
| Building Equitable Surgical Systems: The Role of Peace, Justice, and Gender Inclusive Institutions | ||||||
| Research and Innovation, n (%) | 1 (10.0) | 1 (11.1) | 3 (23.1) | 1 (8.3) | 1 (8.3) | 7 (12.5) |
| Research Session | Research Session | Journal Club as a Mean to Advance Research | Representation of Women in Scientific Research Journals | Applications of AI in Global Surgery | ||
| Innovations in Global Surgery | ||||||
| Breaking Barriers and Promoting Equity in Research in Surgery | ||||||
| Mentorship and Career Development, n (%) | 1 (10.0) | 1 (11.1) | 2 (15.4) | 1 (8.3) | 1 (8.3) | 6 (10.7) |
| Mentorship Session | Is an Academic Career the Right Fit for Me? | Mentorship: How to Make the Best of This Relationship | Navigating Mentor–Mentee Relationships | Identifying Microaggressions in Surgical Systems and Learning How to Deal with Them | ||
| Youth in Global Surgery | ||||||
| Work‑Life Balance and Gender Expectations, n (%) | 0 (0) | 0 (0) | 3 (23.1) | 1 (8.3) | 0(0) | 4 (7.1) |
| Women in Surgery: The Experience of The First Woman to Perform a Liver Transplant | Escaping War and Conflict as a Female Pediatric Surgeon in Afghanistan | |||||
| Family Planning and Work‑Life Integration | ||||||
| Addressing Health‑Care Workers’ Mental Health | ||||||
| Regional Insights, n (%) | 3 (30.0) | 0 (0) | 0 (0) | 0 (0) | 0(0) | 3 (5.4) |
| Centering the Global South | ||||||
| Regional Session (WPRO and SEARO) | ||||||
| Regional Session (EURO and AFRO) | ||||||
| GEIGS Internal Insights, n (%) | 2 (20.0) | 0 (0) | 1 (7.6) | 0 (0) | 1(8.3) | 4 (7.1) |
| Panel with Junior Advisors and Founders | History of GEIGS | History of GEIGS | ||||
| Message from the Chairs | ||||||
[i] Note: Table 4 describes the main themes and corresponding session titles featured at GEIGS General Assemblies from 2020 to 2025. WPRO: Western Pacific Region; SEARO: Southeast Asia Region; AFRO: African Region; EURO: European Region; SDGs: Sustainable Development Goals.
Discussion
This retrospective analysis of speaker representation at the GEIGS GA from 2020 to 2025 provides a descriptive case study, demonstrating consistently high female participation while also highlighting persistent gaps in research visibility and specialty representation. Across all assemblies, women comprised 83.7% of speakers, a proportion markedly higher than global trends, where women often constitute fewer than 30% of academic faculty in HICs and even fewer in LMICs [11, 12]. These findings illustrate that a deliberate, mission‑driven approach to conference design, emphasizing equitable participation, can support female engagement and visibility within the global surgery community [13, 14].
LMIC speakers accounted for 39.4% of participants, many of whom held leadership roles or advanced degrees, consistent with the conference’s emphasis on diverse involvement. A high proportion of speakers had prior conference experience (68.3%), and early‑career professionals were represented in both LMIC and HIC groups (12.2% vs. 17.5% medical students), suggesting that the assembly included a broad range of career stages. LMIC speakers had a lower median citation count (53 vs. 253), which may reflect broader disparities in research infrastructure, access to mentorship, and publishing opportunities [15–17]. Leadership roles and multiple‑degree attainment were broadly comparable between LMIC and HIC speakers, showing that diverse participation is achievable in this conference context [7].
Distribution across specialties was highest in obstetrics and gynecology, neurosurgery, global surgery, and trauma surgery, with underrepresentation in fields such as transplant, urology, and anesthesiology. These patterns may be influenced by existing gender imbalances within specialties and differences in access to global health opportunities [18–20]. Future assemblies may consider targeted strategies to balance specialty representation, track speaker trajectories over time, and implement inclusive recruitment practices to enhance diversity across disciplines [21, 22].
The most frequently addressed topic across the five assemblies was Diversity, Gender Equity, and Inclusion, highlighting the central role of these principles within GEIGS and the broader global surgery academic community. Sessions on Advocacy, Policy, and Structural Change and Research and Innovation reflected the organization’s focus on academic advancement. Mentorship, Career Development, and Work‑Life Balance sessions emphasized personal and professional sustainability, while sessions on Regional and GEIGS Internal Insights demonstrate the breadth of topics covered. Collectively, these sessions illustrate a multifaceted approach to promoting representation in global surgery and the inclusion of diverse perspectives.
This study has several limitations. The small sample size limits the generalizability of our findings, and the results should be interpreted as primarily descriptive. The high female representation likely reflects GEIGS’s mission‑driven focus on gender inclusivity rather than broader systemic change. Selection bias is inherent, as a higher proportion of women and speakers from underrepresented backgrounds may have been included compared to other global surgical conferences. Despite these limitations, these data provide insight into how conference planning can shape speaker composition within a single global surgery forum.
In conclusion, intentional planning is key to promoting the participation of women and individuals from underrepresented groups in academic and professional speaking engagements. The GEIGS experience shows that deliberate, mission‑driven program design can achieve high female participation and meaningful representation of LMIC professionals. While these findings may not be generalizable to all contexts, the mentorship programs and policies to support underrepresented voices employed by GEIGS provide a potential framework for other organizations seeking to enhance inclusivity.
Lessons learned
Deliberate design and leadership may enhance women’s and LMIC participation in global surgery events.
Engaging and mentoring LMIC and underrepresented speakers can reduce structural barriers and broaden specialty participation.
Monitoring demographics and session topics can track progress toward inclusion goals.
Collaborative networks and mentorship programs can empower early‑career professionals and amplify underrepresented voices.
Acknowledgements
Brenda Feres: Conceptualization, Investigation, Methodology, Data curation, Formal analysis, Visualization, Resources, Writing—Original draft preparation, Writing—review and editing. Eilene Basu: Investigation, Data curation, Resources, Writing—Original draft preparation. Rabbey Raza Khan: Investigation, Resources, Data curation, Writing—Original draft preparation. Anna Mary Jose: Investigation, Data curation, Resources, Writing—Original draft preparation. Abeba Aleka Kebede: Resources, Data curation, Writing—Original draft preparation. Camila Sotomayor: Resources, Data curation, Writing—Original draft preparation. Marina Reis: Resources, Data curation, Writing—Original draft preparation. Kaela Blake: Methodology, Resources, Writing—review and editing. Jessica L. Buicko Lopez: Methodology, Resources, Writing—review and editing. Tanaz Vaghaiwalla: Conceptualization, Methodology, Validation, Supervision, Writing—Original draft preparation, Writing—review and editing
Competing Interests
The authors have no competing interests to declare.
Funding
This research did not receive any specific grant from funding agencies in the public, commercial, or not‑for‑profit sectors.