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Ana Velázquez Mañana, MD, MSc, discusses survey findings that revealed gender equity training for oncology fellows is often lacking.
Ana Velázquez Mañana, MD, MSc
Although gender equity issues in oncology education and patient care remain pervasive, fellows are often undereducated in terms of the frequency of these issues and how to address them, according to Ana Velázquez Mañana, MD, MSc.
Velázquez Mañana coauthored a survey, the results of which were published in the Journal of Cancer Education. Velázquez Mañana and her coauthors sent an online survey to 171 hematology/oncology fellowship program directors across the US. Survey respondents (n = 56) indicated that they felt training in gender equity issues was somewhat to very important to patient care, at a rate of 69.6%. Notably, they also indicated that this type of training was somewhat to very important to the physician workforce at a high rate (80.4%).
Despite these responses, the directors mostly indicated that their programs do not provide gender equity training in terms of patient care (83.9%) or the physician workforce (78.6%). The most common reason for not offering these educational programs for oncology fellows was a lack of resources. Respondents were interested in resources for patient (93.9%) and physician (88.6%) gender equity education and were often open to sharing training materials on the subject with physicians (66.7%).
“Our goal was to understand if there were any types of specific training related to gender differences in patient care and the oncology workforce that were currently being offered to trainees,” Velázquez Mañana said in an interview with Oncology Fellows. “If those were nonexistent, [we wanted to know] if program directors were open to implementing them into the regular training of fellows. [We also wanted to identify] opportunities for synergy and development.”
Velázquez Mañana is the assistant director of Diversity, Equity, Inclusion, and Accessibility for Trainees at the University of California San Francisco (UCSF) Helen Diller Family Comprehensive Cancer Center, as well as an assistant clinical professor of medicine at UCSF. In the interview, Velázquez Mañana discussed the far-reaching effects of gender equity issues in cancer care, the significance of the findings of the survey she coauthored, and how the field can move forward in a more equitable direction for all individuals regardless of gender.
Velázquez Mañana: Gender equity affects multiple aspects of oncology, one being patient care, [which includes] the experiences of our female patients getting access to care, their needs that may be different from their male counterparts, and the potential toxicities they may experience when receiving cancer care. Research is another aspect that is affected. For example, fertility preservation for younger [female] patients and the toxicities of some of our newer drugs, such as immunotherapies and targeted therapies, are often understudied [in women]. Women are also more likely to not enroll in clinical studies for reasons that are unclear.
In terms of the workforce in oncology, there’s been an increasing trend of representation of women, [but] we’re still not at parity. There have [also] been increasing trends of inclusion of women in medical schools [as well as in] different medical subspecialties, [but] oncology is not one in which there are many women compared with some of the others. Across academic medicine in general, women tend to [experience] disparities in salaries, promotions, and leadership positions.
At the medical society level, the American Society of Clinical Oncology [ASCO] has the Women’s Networking Center, which usually takes place during the ASCO Annual Meeting, and has a group of women leaders who organize fundraising through the Conquer Cancer foundation to develop investigators who are women. Those efforts are important for us to advance the education and growth of female investigators. But [efforts such as these] can always be expanded to focus not only on early career [investigators] but also on those who are arriving at their faculty positions. How do we ensure that women are able to continue their research goals through their mid-career stages and achieve professional and leadership positions so they can keep mentoring younger women?
On the fellowship level, there are fewer national programs. The American Society of Hematology had a mentorship program for women [that it] piloted [in 2021] called the Blood Sisters Project. But [overall], there is less of a nationwide proposition of trying to integrate the career development of women, besides [through] young investigator awards.
In my institution, we’ve had a Women in Hematology/Oncology group over the years and there’s been women’s leadership development across all graduate medical education that focuses on trainees to provide them with leadership, development, and negotiation skills. [These initiatives help with] finding a job and how to process [events such as] having a family during training.
There [are still] a lot of areas where we can build more resources in those aspects. [For example], in my institution, there are certain resources [available] and at another there may be different ones. Usually, the ability for institutions to create these kinds of programs will depend on their size and whether they have faculty who are invested. If there are opportunities [available] for creating networks or partnerships, that may lead to more individuals approaching them [to access these resources].
[Our findings] were based on the self-reported experiences of the program directors who are leading the education and training of fellows. We found that there were very few institutions that had anything currently implemented [in terms of] gender equity [training], even though they thought that it was important, particularly [since] it affects how trainees [provide] good care for patients. [These data] help us to know that there is a need and an appetite for developing more resources for the career development and education of fellows, as well as the potential for partnerships with groups that are focused on medical education in gender equity.
The most important part is [that these findings] will hopefully lead to the development of partnerships across medical educators and institutions so that we can develop and test the use of some gender equity–focused curricula.
There are other investigators, including Ariela L. Marshall, MD, who is the senior author of the article [in the Journal of Cancer Education], who are very invested in medical education in gender equity and are looking to continue to build these efforts and curricula.
At my institution, we have performed studies, surveys, and interviews with women at the faculty level to try to understand their experiences and [identify] areas where we can create support. We have been piloting programs that [include] one-on-one coaching to ensure that [female investigators] have the tools they need to continue to grow during their [career] transition. I believe there is a lot of room to create similar programs for the transition from fellowship training to faculty, as many trainees do not necessarily have the tools for negotiation or the ability to identify their goals. Piloting some of those [programs] and developing toolkits that can be easily adopted across different programs are interesting next steps [for gender equity training].
Hum CE, Velazquez AI, Marshall AL. Gender equity education in oncology: a survey study of hematology-oncology fellowship program directors. J Cancer Educ. Published online February 18, 2025. doi:10.1007/s13187-025-02591-5
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