# Gender differences in audience participation at infectious disease and microbiology conferences: a prospective observational study

Sarah Dellière, Danila Seidel, Valentine Marie Ferré, Ruchi Agrawal, Audrey Baron, Valentine Berti, Typhaine Brual, Muge Cevik, Adélaïde Chesnay, Clarisse Dupin, et al.

<figure><img src="image_1.png" /></figure>

## ► To cite this version:

Sarah Dellière, Danila Seidel, Valentine Marie Ferré, Ruchi Agrawal, Audrey Baron, et al. Gender differences in audience participation at infectious disease and microbiology conferences: a prospective observational study. Clinical Microbiology and Infection, 2026, 32 (2), pp.323-330. 10.1016/j.cmi.2025.11.005. hal-05463745

HAL Id: hal-05463745

https://hal.science/hal-05463745v1

Submitted on 20 Jan 2026

HAL is a multi-disciplinary open access archive for the deposit and dissemination of scientific research documents, whether they are published or not. The documents may come from teaching and research institutions in France or abroad, or from public or private research centers.

L'archive ouverte pluridisciplinaire HAL, est destinée au dépôt et à la diffusion de documents scientifiques de niveau recherche, publiés ou non, émanant des établissements d'enseignement et de recherche français ou étrangers, des laboratoires publics ou privés.

<figure><img src="image_2.png" /></figure>
Original article

Gender differences in audience participation at infectious disease and microbiology conferences: a prospective observational study

Sarah Dellière 1, 2, *, Danila Seidel 3, 4, Valentine Marie Ferré 5, 6, Ruchi Agrawal 7,
Audrey Baron 8, Valentine Berti 9, 10, Typhaine Brual 11, Muge Cevik 12,
Adélaïde Chesnay 13, 14, Clarisse Dupin 15, Marion Dutkiewicz 16,
Théo Ghelfenstein-Ferreira 1, Marion Helary 17, Yousra Kherabi 5, 18, Katharina Last 19,
Mathieu Lepas 20, 21, Sébastien Ortiz 22, Ilan S. Schwartz 23, Rosanne Sprute 3, 4, 24,
Cécile Angebault 25, 26, 27, Maud Salmona 17, 28 on behalf of the MicroID EmpowHERment
consortium†

<footnote n="1">1) Université Paris Cité, Assistance Publique Des Hôpitaux de Paris (AP-HP), Parasitology-Mycology Department, Groupe Hospitalier Saint-Louis-Lariboisière-Fernand-Widal, Paris, France</footnote>

<footnote n="2">2) Institut Pasteur, Université de Paris Cité, Mycology Department, Immunology of Fungal Infection, Paris, France</footnote>

<footnote n="3">3) University of Cologne, Faculty of Medicine and University Hospital Cologne, Institute of Translational Research, Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases, Cologne, Germany</footnote>

<footnote n="4">4) University of Cologne, Faculty of Medicine and University Hospital Cologne, Department I of Internal Medicine, Division of Infectious Diseases, Excellence Center for Medical Mycology, and Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Cologne, Germany</footnote>

<footnote n="5">5) INSERM (Institut National de la Santé et de la Recherche Médicale), IAME (Infection, Antimicrobials, Modelling, Evolution), Paris Cité University, Paris, France</footnote>

<footnote n="6">6) AP-HP, Bichat-Claude Bernard Hospital, Virology Department, Paris, France</footnote>

<footnote n="7">7) Institut Pasteur, Université Paris Cité, National Reference Center for Invasive Mycoses and Antifungals, Translational Mycology Group, Mycology Department, Paris, France</footnote>

<footnote n="8">8) AP-HP, Hôpital Robert Debré, Microbiology Department, Paris, France</footnote>

<footnote n="9">9) Medical and Infectious Diseases ICU (MI2) Department, AP-HP, Bichat Hospital, Université Paris Cité, Paris, France</footnote>

<footnote n="10">10) Bacteriology Department, AP-HP, Bichat Hospital, Université Paris Cité, Paris, France</footnote>

<footnote n="11">11) Microbiology Department, Adaptation, Pathogénie (MAP), UMR5240, Lyon, France</footnote>

<footnote n="12">12) Division of Infection and Global Health Research, School of Medicine, University of St Andrews, United Kingdom</footnote>

<footnote n="13">13) Service de Parasitologie-Mycologie-Médecine Tropicale, Pôle Biologie Médicale, Hôpital Bretonneau, CHRU de Tours, Tours, France</footnote>

<footnote n="14">14) Centre d'Etude des Pathologies Respiratoires, UMR (Unité Mixte de Recherche) 1100, INSERM, Tours, France</footnote>

<footnote n="15">15) Microbiology Department, Centre Hospitalier de St Brieuc, Saint-Brieuc, France</footnote>

<footnote n="16">16) Université Paris Cité, AP-HP, Paris, France</footnote>

<footnote n="17">17) Virology Department, AP-HP, Saint-Louis Hospital, Paris, France</footnote>

<footnote n="18">18) Infectious and Tropical Diseases Department, Bichat-Claude Bernard Hospital, Assistance Publique-Hôpitaux de Paris, Université Paris Cité, Paris, France</footnote>

<footnote n="19">19) University Hospital Bonn, Institute for Hygiene and Public Health, Bonn, Germany</footnote>

<footnote n="20">20) Life and Health Sciences Research Institute, University of Minho, Braga, Portugal</footnote>

<footnote n="21">21) ICVS/3B's-PT (Instituto de investigação em ciencias da vida e Saúde/Biomaterials, Biodegradables and Biomimetics-Portugal), Government Associate Laboratory, Guimarães, Braga, Portugal</footnote>

<footnote n="22">22) Manchester Academic Health Science Centre, Core Technology Facility, Manchester Fungal Infection Group, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom</footnote>

<footnote n="23">23) Division of Infectious Diseases, Department of Medicine, Duke University, Durham, NC, USA</footnote>

<footnote n="24">24) German Centre for Infection Research, Partner Site Bonn Cologne, Cologne, Germany</footnote>

<footnote n="25">25) Unité de Parasitologie-Mycologie, Département de Prévention, Diagnostic et Traitement Des Infections, CHU (Centre Hospitalo-Universitaire) Henri Mondor, AP-HP, Creteil, France</footnote>

<footnote n="26">26) UR Dynamyc 7380, Faculté de Santé, Univ Paris-Est Creteil, Ecole Nationale Vétérinaire d'Alfort, France</footnote>

<footnote n="27">27) USC (Unité Sous Contrat) Anses, Maisons-Alfort, France, Creteil, France</footnote>

<footnote n="28">28) Biology and Pathogenesis of Viral Infection Team, INSERM UMR1342, Saint-Louis research institute, Université Paris Cité, Paris, France</footnote>

<footnote>* Corresponding author. Sarah Dellière, Parasitology-Mycology Department, Université Paris Cité, Assistance Publique Des Hôpitaux de Paris, Hôpital Saint-Louis, 1 avenue Claude Vellefaux, 75010 Paris, France.</footnote>

<footnote>E-mail address: sarah.delliere@aphp.fr (S. Dellière).</footnote>

<footnote>† A list of the members of the MicroID EmpowHERment consortium is included in Appendix section.</footnote>
ARTICLE INFO

Article history:

Received 14 August 2025
Received in revised form
24 October 2025
Accepted 6 November 2025
Available online 12 November 2025

Editor: L. Scudeller

Keywords:

Academic conferences
Gender equity
Leadership
Medical societies
Scientific visibility
Women in STEM

A B S T R A C T

**Objectives:** In medicine, women constitute a large proportion of the workforce but remain under-represented in senior positions. Scientific conferences, critical for career advancement, reflect these inequities, with prior studies documenting gender gaps in invited speakers. However, less attention has been given to audience engagement, such as asking questions or making comments, which also enhances professional visibility. This study investigates gender differences in audience participation at infectious disease and clinical microbiology conferences, examining their prevalence, contextual variation, and potential structural drivers.

**Methods:** This prospective observational study recorded audience participations during national and international infectious disease and clinical microbiology conferences (October 2023–October 2024). Consortium members documented eligible sessions with traditional presentation–discussion formats, noting gender, role, and type of participation. Statistical analyses compared observed gender proportions with attendee distributions and examined factors associated with women’s participation.

**Results:** A total of 298 sessions from 24 conferences were analysed, comprising 1873 audience participations. Women delivered 47.8% of presentations (n = 487/1018; 95% CI, 44.8–50.9%) but accounted for only 36.4% of participations (n = 681/1873; 95% CI, 34.2–38.5%), significantly fewer than men both in absolute terms and relative to their representation among attendees (p < 0.001). Multivariable analysis showed women were more likely to intervene when at least one moderator was female (OR = 1.44; 95% CI, 1.02–2.04%; p 0.037), with a stronger effect when all moderators were women (OR = 2.12; 95% CI, 1.40–3.24%; p < 0.001), and when the first question was asked by a woman (OR = 1.35; 95% CI, 1.00–1.81%; p 0.046).

**Conclusion:** Our findings highlight actionable levers to advance equity. Addressing participation gaps and raising awareness of gender disparities are essential to foster inclusive visibility, empower women, and strengthen scientific innovation. Sarah Dellière, Clin Microbiol Infect 2026;32:323

© 2025 The Author(s). Published by Elsevier Ltd on behalf of European Society of Clinical Microbiology and Infectious Diseases. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).

Introduction

Despite notable progress, achieving gender equity in science, technology, engineering, and mathematics remains an ongoing challenge. In medicine, women now comprise most of the workforce in many countries, yet remain underrepresented in academic and medical leadership [1,2]. This disparity reflects a complex interplay of personal, institutional, and societal barriers, known as the ‘leaky pipeline’, describing women’s attrition at successive stages of advancement in male-dominated fields [3]. Gender gaps are apparent across multiple domains, including research funding [4], editorial positions [5], authorship [6], citations [7] and visibility [8]. Scientific and medical conferences shape careers by offering opportunities to disseminate research, build networks, and gain visibility [9]. Unequal access to these forums can reinforce broader inequities [10].

Over the past decade, studies have documented persistent gender disparities in speaker invitations, particularly in high-profile sessions [11]. A higher proportion of women on planning committees correlates with greater representation among speakers, affirming that inclusion fosters further inclusion [12]. In response, several professional societies have taken steps to address these imbalances, achieving rapid and sustained progress toward gender parity among chairs and invited speakers [11,13].

However, equal representation among chairs and invited speakers does not necessarily translate into equal participation across all conferences activities. Active participation during scientific sessions, such as asking questions or making comments, is another important but often overlooked marker of visibility and influence [14]. These participations provide opportunities to seek clarification, share insights, and enhance professional reputation. However, anecdotal experience and emerging data suggest that women may continue to face barriers limiting their full participation in these visible spaces [15,16].

In this study, we assessed gender disparities in audience engagement during scientific sessions at infectious disease and clinical microbiology conferences. Building on prior efforts examining speaker representation, we focused specifically on gender differences in audience participation during scientific sessions. Our objectives were to determine whether such differences exist, quantify them, and explore structural or contextual factors influencing women's participation in these essential, yet less formalized, academic interactions.

Methods

Study design

This prospective observational study examined audience participations during national and international infectious disease and clinical microbiology conferences held between October 2023 and October 2024. Members of the MicroID EmpowHERment consortium [17] recorded eligible sessions they attended, selected by convenience. During the study period, the consortium comprised 57 members, of whom 16% were men (n = 9) and 84% were women (n = 48). Data were collected through an online form at attendance (please see supplementary material). Eligible sessions followed a traditional format of formal presentations and a question-and-answer segment; alternative formats (workshops, round tables, panel discussions) were excluded. For each session, we recorded the gender of moderators, speakers, and intervening audience members, type of participation (question or comment), session title and type (plenary, selected abstract, or both). Questions were defined as concise inquiries seeking clarification or elaboration; comments as statements expressing opinions or insights without seeking a direct response. Combined participations were classified as comments. Participations from moderators or online participants were excluded. Gender was inferred as female-presenting (women) or male-presenting (men).
Although the data collection form included a nonbinary option, no such cases were recorded during the study period. For conferences with ≥5 recorded sessions, organizing committees were contacted for data on registered participants, gender distribution, and proportion of young attendees, as defined by each organizing body.

## Statistical analysis

Descriptive statistics were computed for all variables. Categorical variables were summarized as counts and percentages, and continuous variables as medians with interquartile ranges (IQR). Group comparisons were made using chi-squared or Fisher exact tests for categorical variables, and Wilcoxon rank-sum tests for continuous variables, as appropriate. A binomial test was used to compare the observed proportion of participations made by women with the expected proportion based on the percentage of women among participants. Pearson correlation was used to assess the association between the proportion of questions asked by women and (a) the proportion of women among speakers and (b) the estimated proportion in the audience inferred from conference attendee data. Factors associated with the gender of the person intervening were assessed using logistic regression. Variables associated with the outcome in univariable analysis (p < 0.10) and those considered clinically relevant were included in the multivariable model. Clustering of sessions within conferences was evaluated (intraclass correlation coefficient, ICC <0.05), indicating negligible between-conference variability. Collinearity was checked (variance inflation factor, VIF <2), and a complete-case analysis was performed. Model fit was evaluated using the likelihood ratio and Hosmer-Lemeshow tests. Results are reported as adjusted odds ratios (OR) with 95% CIs. Analyses were performed using R version 4.3.0 and the packages finalfit (developed by Ewen Harrison, Tom Drake, Riinu Pius), rms (developed by Frank E. Harrell Jr), and gtsummary (developed by Daniel B. Magee et al).

## Results

### Conferences and sessions

A total of 369 sessions from 24 conferences were prospectively recorded during the 12-month study window. Conferences were international (42%, n = 10) or national (58%, n = 14) from six countries: France, the United Kingdom, Spain, Germany, Ireland, and the United States. For conferences where demographic data were acquired, women represented 55% of all registered delegates (Table S1). After excluding duplicate sessions with identical titles attended by several consortium members, 298 unique sessions were analysed, yielding 1873 recorded participations. Sessions characteristics are detailed in Table 1.

Women delivered 47.8% of all presentations (n = 487/1018, 95% CI, 44.8–50.9%) and accounted for 36.4% of all recorded participations (n = 681/1873, 95% CI, 34.2–38.5%). Plenary sessions, composed exclusively of invited speakers, represented 66% (n = 198/298) of all recorded sessions. The median number of speakers per session was 3 (IQR, 2–5). Regarding session moderation, most sessions were led by mixed-gender teams (47%, n = 139/298), followed by men-only (32%, n = 96/298) and women-only (21%, n = 62/298) moderator groups. Few differences were observed between international and national conferences (Table 1). Median number of speakers per session was higher at international than national conferences (4 (IQR, 2–5) vs. 3 (IQR, 2–4); p 0.015). The proportion of women speakers per session was comparable across international and national conferences, with a median of 50% (IQR, 25–60%).

### Participations

The median number of audience participations per session was 6 (IQR, 3–8) overall and was comparable between national and international conferences (6 (IQR, 4–9) vs. 5 (IQR, 3–8); p 0.06). At least one participation was recorded in 91.6% of sessions (n = 273/

<table><caption>**Table 1**

Characteristics of participants and sessions</caption><thead><tr><th colspan="6">Gender representation among participants</th></tr></thead><tbody><tr><td>Characteristics of participants</td><td>Overall (n = 25 727/27 322)<sup>a)</sup></td><td>International (n = 19 007/20 602)<sup>a)</sup></td><td>National (n = 6720/6720<sup>a)</sup></td><td>p<sup>c</sup></td></tr><tr><td>Women</td><td>14 173 (55%)</td><td>10 199 (54%)</td><td>3974 (59%)</td><td>&lt;0.001</td></tr><tr><td>Young scientists (all gender)<sup>d</sup></td><td>4803 (19%)</td><td>3585 (19%)</td><td>1218 (18%)</td><td>0.018</td></tr><tr><td>Type of session</td><td></td><td></td><td></td><td></td></tr><tr><td>Characteristics of sessions</td><td>Overall<br/>N = 298</td><td>International<br/>N = 163</td><td>National<br/>N = 135</td><td>p<sup>c</sup></td></tr><tr><td>Session type</td><td></td><td></td><td></td><td>0.041</td></tr><tr><td>Plenary session (invited speakers only)</td><td>198 (66%)</td><td>100 (61%)</td><td>98 (73%)</td><td></td></tr><tr><td>Mixed session (invited speakers and selected abstract)<br/>or selected abstract only</td><td>100 (34%)</td><td>63 (39%)</td><td>37 (27%)</td><td></td></tr><tr><td>No. of speaker/session median (IQR)</td><td>3.00 (2.00, 5.00)</td><td>4.00 (2.00, 5.00)</td><td>3.00 (2.00, 4.00)</td><td>0.015</td></tr><tr><td>Percentage of women speakers/session</td><td>0.50 (0.25, 0.60)</td><td>0.50 (0.25, 0.60)</td><td>0.50 (0.33, 0.67)</td><td>0.8</td></tr><tr><td>Median (IQR)</td><td></td><td></td><td></td><td>0.014</td></tr><tr><td>Moderators</td><td></td><td></td><td></td><td></td></tr><tr><td>Men/Women</td><td>139 (47%)</td><td>65 (40%)</td><td>74 (55%)</td><td></td></tr><tr><td>Men only</td><td>96 (32%)</td><td>56 (34%)</td><td>40 (30%)</td><td></td></tr><tr><td>Women only</td><td>62 (21%)</td><td>42 (26%)</td><td>20 (15%)</td><td></td></tr><tr><td>Not assessed</td><td>1</td><td></td><td>1</td><td></td></tr><tr><td>Participations</td><td></td><td></td><td></td><td></td></tr><tr><td>No. of participations per session (median (IQR))</td><td>6 (3, 8)</td><td>5 (3, 8)</td><td>6 (4, 9)</td><td>0.060</td></tr></tbody></table>

<footnote><sup>a</sup> Participants who did not share their gender were excluded from analysis.</footnote>

<footnote><sup>b</sup> n (%); Median (IQR, interquartile range).</footnote>

<footnote><sup>c</sup> Statistical analysis was performed with Pearson's chi-squared test, Wilcoxon rank-sum test, and Fisher exact test as appropriate.</footnote>

<footnote><sup>d</sup> Percentage of young participants, as defined by each conference organizing body.</footnote>
<figure><img src="image_3.png" /><figcaption>**Fig. 1.** Analysis of audience interaction at 24 infectious disease and microbiology conferences. Binomial test of proportion of participation compared to the proportion of participants for women and men. A two-proportion Z-test was used to compare the percentage of women vs. men participations (% women vs. % men).</figcaption></figure>

298, 95% CI, 88.2–94.4%). Women participated significantly less than men, both in absolute terms (36.0% vs. 64.0%) and relative to their representation among participants (p < 0.001; Fig. 1). Men made a median of 4 participations per session (IQR, 2–6) and women 2 (IQR, 1–4) (p < 0.001). Characteristics by gender are presented in Table 2 and Fig. 2. The proportion of participation by women per conference is detailed in Table S2. Among the 14 conferences with available attendee gender data, women intervened significantly less often than expected in 12 conferences, with no significant difference in 2 (Table S3).

No significant difference was observed between participation types (36.5% of questions vs. 35.9% of comments; p 0.8). Among conferences with available participant gender data, a positive correlation was found between the overall proportion of women attendees and that of participations made by women (Pearson's r = 0.77; 95% CI, 0.32–0.94%; p 0.005) (Fig. S1). The gender gap observed varied by conference scope: women accounted for 40.6% (95% CI, 37.5–43.9%) of participations at national vs. 32.3% (95% CI, 29.5–35.5%) at international conferences (p < 0.001) (Fig. S2).

## Factors associated with increased audience participation by women

Univariable analysis identified several factors positively associated with a higher proportion of women's participation (Table S4). Multivariable analysis identified that women in the audience were more likely to intervene when at least one moderator was a woman (OR = 1.44; 95% CI, 1.02–2.04%; p 0.037), with a stronger effect when all moderators were women, whether in sessions with a single female moderator or with two female moderators (OR = 2.12; 95% CI, 1.40–3.24%; p < 0.001), and when the first question in the session was asked by a woman (OR = 1.35; 95% CI, 1.00–1.81%; p 0.046) (Table 3, Fig. 3).

## Discussion

In this prospective observational study, gender parity among speakers was nearly achieved, with women comprising 47.8% overall. However, our analysis reveals a significant disparity in audience engagement: women participated markedly less in question-and-answer sessions. This reduced visibility reflects

persistent structural and social barriers to equal participation [18]. Our investigation identifies key factors that correlate with increased participation by women, notably the presence of women moderators and sessions where a woman was first to participate. These findings suggest that visible participation by women contributes to a more inclusive environment, which may mitigate social inhibitions that disproportionately affect women in public academic discourse.

The gender gap in oral participation has long been recognized in public domains such as journalism and politics, with foundational studies dating to the 1970s [19]. In medicine and science, technology, engineering, and mathematics, similar patterns persist despite progress toward parity in speaker representation, panel composition, and leadership roles [15,16,20]. Although the underrepresentation of women in senior academic ranks is often cited as a contributing factor, gender differences in participation persist even after adjusting for age and seniority [15,20]. The presence of women moderators remains one of the most consistent predictors of increased participation [15,16]. This likely reflects a greater sense of comfort or perceived inclusivity among attendees; interestingly, the same effect is not observed with women speakers. Women moderators may more readily select questions from women; however, the positive effect persists even when questioners self-select by microphone queue, as in the congress of the European Society of Clinical Microbiology and Infectious Diseases (ESCMID Global) subset. The gender of the first questioner could also significantly influence subsequent participation, suggesting a role-model effect noted in other studies [16]. Notably, women's participation tended to be lower at international conferences compared to national ones. This pattern may reflect the more intimidating atmosphere of larger international events, as well as the broader inclusion of women from regions where structural or cultural gender barriers are more pronounced. National conference data in this study originated from the United States and Western Europe, where such barriers may be comparatively lower. Our finding that women represented 47.8% of speakers aligns with the most recent findings and may reflect both the growing representation of women in science and shifting norms in conference organization [11,13]. Prior studies have emphasized that conferences achieving gender parity were often
<table><caption>**Table 2**

Characteristics of participation according to gender</caption><thead><tr><th>Characteristics</th><th>Overall (N = 1873<sup>a</sup>)</th><th>Women (N = 681<sup>a</sup>)</th><th>Men (N = 1192<sup>a</sup>)</th><th>p<sup>b</sup></th></tr></thead><tbody><tr><td>Conference type</td><td></td><td></td><td></td><td>&lt;0.001</td></tr><tr><td>International</td><td>965 (100%)</td><td>312 (32%)</td><td>653 (68%)</td><td></td></tr><tr><td>National</td><td>908 (100%)</td><td>369 (41%)</td><td>539 (59%)</td><td></td></tr><tr><td>Conference specialty</td><td></td><td></td><td></td><td>&lt;0.001</td></tr><tr><td>CM</td><td>143 (100%)</td><td>66 (46%)</td><td>77 (54%)</td><td></td></tr><tr><td>CM_ID</td><td>587 (100%)</td><td>225 (38%)</td><td>362 (62%)</td><td></td></tr><tr><td>ID</td><td>161 (100%)</td><td>54 (34%)</td><td>107 (66%)</td><td></td></tr><tr><td>Mycology</td><td>885 (100%)</td><td>287 (32%)</td><td>598 (68%)</td><td></td></tr><tr><td>Virology</td><td>97 (100%)</td><td>49 (51%)</td><td>48 (49%)</td><td></td></tr><tr><td>Conference size</td><td></td><td></td><td></td><td>0.7</td></tr><tr><td>&lt;500 participants</td><td>474 (100%)</td><td>178 (38%)</td><td>296 (62%)</td><td></td></tr><tr><td>≥500 participants</td><td>1250 (100%)</td><td>456 (36%)</td><td>794 (64%)</td><td></td></tr><tr><td>Unknown</td><td>149</td><td>47</td><td>102</td><td></td></tr><tr><td>% Women attendees/conference</td><td></td><td></td><td></td><td>&lt;0.001</td></tr><tr><td>&lt; 50%</td><td>137 (100%)</td><td>28 (20%)</td><td>109 (80%)</td><td></td></tr><tr><td>≥ 50%</td><td>1358 (100%)</td><td>521 (38%)</td><td>837 (62%)</td><td></td></tr><tr><td>Unknown</td><td>378</td><td>132</td><td>246</td><td></td></tr><tr><td>Session type</td><td></td><td></td><td></td><td>0.4</td></tr><tr><td>Invited speaker/plenary</td><td>1095 (100%)</td><td>407 (37%)</td><td>688 (63%)</td><td></td></tr><tr><td>Mixed session (invited speakers and selected abstract) or selected abstract only</td><td>778 (100%)</td><td>274 (35%)</td><td>504 (65%)</td><td></td></tr><tr><td>Moderators gender</td><td></td><td></td><td></td><td>&lt;0.001</td></tr><tr><td>Men and women</td><td>856 (100%)</td><td>325 (38%)</td><td>531 (62%)</td><td></td></tr><tr><td>Men only</td><td>613 (100%)</td><td>172 (28%)</td><td>441 (72%)</td><td></td></tr><tr><td>Women only</td><td>400 (100%)</td><td>183 (46%)</td><td>217 (54%)</td><td></td></tr><tr><td>Unknown</td><td>4</td><td>1</td><td>3</td><td></td></tr><tr><td>Speaker gender</td><td></td><td></td><td></td><td>0.7</td></tr><tr><td>Female</td><td>908 (100%)</td><td>327 (36%)</td><td>581 (64%)</td><td></td></tr><tr><td>Male</td><td>950 (100%)</td><td>351 (37%)</td><td>599 (63%)</td><td></td></tr><tr><td>Unknown</td><td>15</td><td>3</td><td>12</td><td></td></tr><tr><td>Participation order</td><td></td><td></td><td></td><td>0.9</td></tr><tr><td>1</td><td>747 (100%)</td><td>264 (35%)</td><td>483 (65%)</td><td></td></tr><tr><td>2</td><td>520 (100%)</td><td>187 (36%)</td><td>333 (64%)</td><td></td></tr><tr><td>3</td><td>320 (100%)</td><td>120 (38%)</td><td>200 (63%)</td><td></td></tr><tr><td>4</td><td>151 (100%)</td><td>56 (37%)</td><td>95 (63%)</td><td></td></tr><tr><td>5</td><td>90 (100%)</td><td>34 (38%)</td><td>56 (62%)</td><td></td></tr><tr><td>6</td><td>45 (100%)</td><td>20 (44%)</td><td>25 (56%)</td><td></td></tr><tr><td>Participation type</td><td></td><td></td><td></td><td>0.8</td></tr><tr><td>Comment(s)</td><td>357 (100%)</td><td>128 (36%)</td><td>229 (64%)</td><td></td></tr><tr><td>Question(s)</td><td>1516 (100%)</td><td>553 (36%)</td><td>963 (64%)</td><td></td></tr><tr><td>No. of speakers by session</td><td>4 (3, 5)</td><td>4 (3, 5)</td><td>4 (3, 5)</td><td>0.4</td></tr><tr><td>Percentage of women speakers by session</td><td>0.50 (0.33, 0.67)</td><td>0.50 (0.33, 0.67)</td><td>0.50 (0.33, 0.60)</td><td>0.002</td></tr><tr><td>First participation made by</td><td></td><td></td><td></td><td>0.010</td></tr><tr><td>Woman</td><td>403 (100%)</td><td>169 (42%)</td><td>234 (58%)</td><td></td></tr><tr><td>Man</td><td>700 (100%)</td><td>239 (34%)</td><td>461 (66%)</td><td></td></tr><tr><td>NA (First participation or NR)</td><td>770</td><td>273</td><td>497</td><td></td></tr></tbody></table>

CM, clinical microbiology; ID, infectious diseases; NA, not available; NR, not reported.

those organized by scientific societies with explicit gender equity policies in place, highlighting the potential impact of institutional commitments on promoting balanced representation [11,13].

Reduced self-esteem and diminished societal tolerance for assertive female behaviour are major psychological and social barriers to women's active participation at scientific conferences [21–23]. Rooted in stereotypes and cognitive biases acquired early in life and reinforced through socialization, these norms often lead individuals to self-stereotype for acceptance, limiting self-expression [24]. In public speaking, women's speech remains subject to gendered scrutiny, labelled as emotional, high-pitched, or lacking authority, which can discourage engagement and reduce perceived legitimacy [25]. Such biases are often unconscious and systemic, as shown in Beaman et al. study, where identical speeches were rated more favourably when attributed to a man, regardless of the evaluator's gender [26].

These stereotypes can affect performance through the well-documented phenomenon of stereotype threat, whereby awareness of negative stereotypes impairs individuals' confidence and engagement. For example, women's performance has been shown to decline under conditions emphasizing gendered expectations in mathematics [27]. Subsequent studies have replicated the stereotype threat effect across various groups and contexts [28,29]. By analogy, in academic conferences, women may internalize stereotypes about authority and public speaking, which could reduce confidence and limit participation during question-and-answer sessions [30].

This study has several limitations. Classification of moderator, speaker, and audience presenting gender was subjective, with possible misclassification, although likely infrequent and unlikely to affect results substantially. Seniority or academic rank, which can influence the likelihood of asking questions, was not recorded

<footnote>a $n$ (%); Median (Q1, Q3).</footnote>

<footnote>b Pearson's chi-squared test, Wilcoxon rank-sum test, and Fisher exact test as appropriate.</footnote>
<figure><img src="image_4.png" /><figcaption>**Fig. 2.** Distribution of participations by gender and conference or session characteristics. Proportion of participations made by men (yellow) and women (purple) according to various session and conference characteristics, including conference type, gender of the first intervenor, moderators' gender, speakers' gender, type of participation (comment vs. question), and conference gender attendance (>50% women). Percentages represent the share of each gender among total participations within each category. The dotted line represents the global proportion of women attendees at the conference.</figcaption></figure>

<table><caption>**Table 3**
Gender distribution of participations and odds ratios (univariable and multivariable models)</caption><thead><tr><th>Variable</th><th>Category</th><th>Men n (%)</th><th>Women n (%)</th><th>OR (univariable)</th><th>OR (multivariable)</th></tr></thead><tbody><tr><td rowspan="2">Conference type</td><td>International</td><td>653 (67.7)</td><td>312 (32.3)</td><td>—</td><td>—</td></tr><tr><td>National</td><td>539 (59.4)</td><td>369 (40.6)</td><td>1.43 (1.19–1.73, p &lt; 0.001)</td><td>1.19 (0.88–1.61, p 0.265)</td></tr><tr><td rowspan="2">Session type</td><td>Mixed session</td><td>504 (64.8)</td><td>274 (35.2)</td><td>—</td><td>—</td></tr><tr><td>Invited/Plenary</td><td>688 (62.8)</td><td>407 (37.2)</td><td>1.09 (0.90–1.32, p 0.387)</td><td>1.25 (0.92–1.69, p 0.153)</td></tr><tr><td rowspan="2">% Women conference attendance</td><td>&le;50%</td><td>109 (79.6)</td><td>28 (20.4)</td><td>—</td><td>—</td></tr><tr><td>&gt;50</td><td>837 (61.6)</td><td>521 (38.4)</td><td>2.42 (1.60–3.79, p &lt; 0.001)</td><td>2.37 (1.29–4.60, <b>p 0.007</b>)</td></tr><tr><td rowspan="3">Moderators</td><td>Men</td><td>441 (71.9)</td><td>172 (28.1)</td><td>—</td><td>—</td></tr><tr><td>Both</td><td>531 (62.0)</td><td>325 (38.0)</td><td>1.57 (1.26–1.97, p &lt; 0.001)</td><td>1.44 (1.02–2.04, <b>p 0.037</b>)</td></tr><tr><td>Women</td><td>217 (54.2)</td><td>183 (45.8)</td><td>2.16 (1.66–2.82, p &lt; 0.001)</td><td>2.12 (1.40–3.24, <b>p &lt; 0.001</b>)</td></tr><tr><td>% Women speakers by session</td><td>Mean (SD)</td><td>0.5 (0.3)</td><td>0.5 (0.3)</td><td>1.52 (1.07–2.16, p 0.020)</td><td>0.75 (0.43–1.33, p 0.329)</td></tr><tr><td rowspan="2">First participation gender</td><td>Man</td><td>461 (65.9)</td><td>239 (34.1)</td><td>—</td><td>—</td></tr><tr><td>Woman</td><td>234 (58.1)</td><td>169 (41.9)</td><td>1.39 (1.08–1.79, p 0.010)</td><td>1.35 (1.00–1.81, <b>p 0.046</b>)</td></tr></tbody></table>

Bold p values (i.e. p < 0.05) indicate statistically significant associations. Reference categories are denoted by ‘—’.

OR, odds ratio; %, percentage of participation by gender.

<figure><img src="image_5.png" /><figcaption>**Fig. 3.** Multivariable associations with women's participation during conferences. Forest plot shown adjusted odds ratios (ORs) and 95% CIs from a multivariable logistic regression model assessing factors associated with women's participation during conference sessions. Odds ratios >1 indicate increased odds of a woman's participation. Significant associations (p < 0.05) are shown in purple.</figcaption></figure>
and could not be adjusted for. However, prior work has shown that gender differences in participation persist even after controlling for age and seniority [15]. Similarly, distinguishing questions from comments was subjective, and the boundary was not always clear. Most conferences were not observed in full, as consortium members could not attend all parallel sessions, introducing potential selection bias since session coverage was based on convenience rather than randomization. This approach may have influenced the observed magnitude of the effect, although the direction of the bias remains uncertain. If topics attracting more women, who comprise a large share of the consortium, were preferentially recorded, may have been underestimated. In other specialties, 'feminine' themes have been linked to higher female participation in question-asking [16]. A more accurate assessment would require random session selection or systematic recording of attendee gender, which is logistically challenging. Additionally, online question platforms used at some conferences could not be analysed due to the lack of gender-identifying information. Anonymous submission has been shown to increase women's participation, suggesting confidence, rather than willingness, may limit engagement [20]. Finally, the predominance of French national conferences limits statistical power for cross-country comparisons and may bias national versus international analyses. In particular, the convenience sampling strategy and the limited representation of non-European meetings further restrict the generalizability of our findings. Broader sampling across regions and meeting types will be essential to confirm whether the patterns we observed hold globally.

Beyond scientific conferences, there is a pressing need for outreach at the student level. Gender differences in self-esteem peak in late adolescence, suggesting that undergraduate and early graduate students are particularly vulnerable [22]. This formative stage shapes future academic and professional trajectories, and gender disparities observed in our study likely extend to educational settings such as medical lecture halls. Prior research shows similar gaps in student participation, with smaller differences in online or small-group formats [31], and women reporting lower comfort in asking questions [32]. These findings highlight the importance of early, targeted participations within universities to foster equitable participation and promote women's visibility. Closing the gender gap in medicine and science, technology, engineering, and mathematics is not only a matter of equity but also enhances scientific excellence, as gender-diverse teams produce more novel, higher-impact research [33]. While direct evidence linking question-asking to career advancement is limited, active participation is associated with more favourable peer and mentor evaluations [14]. Insights from this study can inform strategies to promote women's engagement and visibility in academic contexts.

## Conclusion

Our findings underscore the need to move beyond documenting gender disparities in public participation at infectious disease and clinical microbiology conferences toward implementing evidence-based solutions. The positive influence of female moderators and the role-model effect of a woman asking the first question suggest actionable levers for change. Structured session design, in which moderators prioritize early questions from women or deliberately invite a woman to open the discussion, could help reduce psychological barriers and signal a welcoming

environment. Raising awareness among all moderators, regardless of gender, through brief equity-focused guidance can promote active inclusion strategies such as scanning for raised hands from women or junior attendees. Although these participations are feasible, scalable, and testable, their implementation should be monitored for unintended effects, such as perceptions of tokenism or moderator bias. Accordingly, they will be piloted and evaluated by the MicroID EmpowHERment consortium across diverse conference formats and cultural contexts. Addressing participation disparities is essential for fostering equitable academic visibility, amplifying diverse perspectives, and building a more inclusive and innovative scientific community where all voices are heard and valued.

## CRediT authorship contribution statement

Sarah Dellière, Maud Salmona, Valentine Berti, Yousra Kherabi, and Typhaine Brual: Conceptualization. Sarah Dellière and Maud Salmona: Writing – Original draft, Methodology, Formal analysis, Data curation. Sarah Dellière, Danila Seidel, Valentine Marie Ferré, Ruchi Agrawal, Audrey Baron, Valentine Berti, Typhaine Brual, Muge Cevik, Adélaïde Chesnay, Clarisse Dupin, Marion Dutkiewicz, Théo Ghelfenstein-Ferreira, Marion Helary, Yousra Kherabi, Katharina Last, Mathieu Lepas, Sébastien Ortiz, Ilan S. Schwartz, Rosanne Sprute, Cécile Angebault, Maud Salmona, and the MicroID EmpowHERment consortium: Writing – Review & editing, Investigation. Sarah Dellière, Maud Salmona, Muge Cevik, and Katharina Last: Visualization. Sarah Dellière: Supervision & Project administration.

## Transparency declaration

### Potential conflict of interest

The authors declare that they have no conflicts of interest.

### Financial report

No funding was acquired for this study.

## Acknowledgements

We are sincerely grateful to Cécile Dehesdin for her time, support, and insight to discuss this work. We are sincerely grateful to scientific societies or conference scientific committees who generously shared gender distribution data for their participants, making this work possible: AAAM (Advances against Aspergillosis and Mucormycosis), ACAI (Association de Chimiothérapie Anti-Infectieuse), CEPI (Colloque Experts Praticiens Infectiologie), ECMM (European Confederation of Medical Mycologists), ESCMID (European Society for Clinical Microbiology and Infectious Diseases), Fungal Updates, HFP (Host Fungal Pathogen, an Advanced Lecture Course from the Federation of European Biochemical Societies), MYK (Deutschsprachigen Mykologischen Gesellschaft), SEIMC (Sociedad Espannolan de Enfermedades Infecciosas y Microbiologia Clinica), SFM (Société Française de Microbiologie), SPILF (Société de Pathologie Infectieuse de Langue Française), SRI (Synergie, Résistances et Immunosuppression).
# Appendix A. Supplementary data

Supplementary data to this article can be found online at
https://doi.org/10.1016/j.cmi.2025.11.005.

## Appendix A

**MicroID EmpowHERment consortium/collaborators:** Salam Abbara, Ana Alastruey-Izquierdo, Laurence Armand-Lefevre, Judith Berman, Margherita Bertuzzi, Jeanne Bigot, Andrés Blanco Di Matteo, Sonia Burrel, Amandine Caillault, Caroline Charre, Laurène Deconinck, Marion Dollat, Cécile Emeraud, Linda Feghoul, Slim Fourati, Maud Gits-Muselli, Claire Hobson, Aude Jary, Brune Joannard, Anna Last, Caroline Lefeuvre, Alban Lemonnier, Mathilde Lescat, Sarah Mafi, Marta Martín García, Miguel Morante Ruiz, Charlotte Pronier, María Riesgo Magaña, Noemie Rybak, Naomi Sayre, Holly Sinclair, Jannik Stemler, Katharine Stott, Aude Sturny-Leclère, Clara Valero.

## References

[1] Joyce JA, Masina S, Michalik L, Pot C, Sempoux C, Amati F. Closing the scissor-shaped curve: strategies to promote gender equality in academia. Cell 2024;187:1335–42. https://doi.org/10.1016/j.cell.2024.01.050.

[2] Organization WH. The global health observatory – medical doctors by sex (%). 2025. https://www.who.int/data/gho/data/indicators/indicator-details/GHO/medical-doctors-by-sex. [Accessed 2 May 2025].

[3] Alper J. The pipeline is leaking women all the way along. Science 1993;260:409–11. https://doi.org/10.1126/science.260.5106.409.

[4] Lerchenmueller MJ, Sorenson O. The gender gap in early career transitions in the life sciences. Res Polic 2018;47:1007–17. https://doi.org/10.1016/j.respol.2018.02.009.

[5] Last K, Hübsch L, Cevik M, Wolkewitz M, Müller SE, Huttner A, et al. Association between women's authorship and women's editorship in infectious diseases journals: a cross-sectional study. Lancet Infect Dis 2022;22:1455–64. https://doi.org/10.1016/s1473-3099(22)00367-x.

[6] Jagsi R, Guancial EA, Worobey CC, Henault LE, Chang Y, Starr R, et al. The "Gender Gap" in authorship of academic medical literature—a 35-year perspective. N Engl J Med 2006;355:281–7. https://doi.org/10.1056/nejmsa053910.

[7] Maliniak D, Powers R, Walter BF. The gender citation gap in international relations. Int Organ 2013;67:889–922. https://doi.org/10.1017/s0020818313000209.

[8] Desai TA, Eniola-Adefeso O, Stevens KR, Vazquez M, Imoukhuede P. Perspectives on disparities in scientific visibility. Nat Rev Mater 2021;6:556–9. https://doi.org/10.1038/s41578-021-00329-5.

[9] Borger JG. The power of networking in science and academia. Immunol Cell Biol 2024;102:871–7. https://doi.org/10.1111/imcb.12832.

[10] Wu Y-Y, Ye R-H, Huang T-C. Additional factors in the association of gender and parenthood with conference attendance. JAMA Oncol 2020;6:159. https://doi.org/10.1001/jamaoncol.2019.5014.

[11] Marcelin JR, Khazanchi R, Lyden E, Cawcutt KA, Ha DR, Florez N, et al. Demographic representation among speakers and program committee members at the IDWeek Conference, 2013–2021. Clin Infect Dis 2022;76:897–904. https://doi.org/10.1093/cid/ciac816.

[12] Lithgow KC, Earp M, Bharwani A, Fletcher S, Ruzycki SM. Association between the proportion of women on a conference planning committee and the proportion of women speakers at medical conferences. JAMA Netw Open 2020;3:e200677. https://doi.org/10.1001/jamanetworkopen.2020.0677.

[13] Last K, Hübsch L, Marcelin JR, Huttner A, Cevik M, Papan C. Gender and geographical representation at infectious diseases and clinical microbiology

conferences. Lancet Infect Dis 2024;24:e153–4. https://doi.org/10.1016/S1473-3099(23)00824-1.

[14] Huang K, Yeomans M, Brooks AW, Minson J, Gino F. It doesn't hurt to ask: question-asking increases liking. J Pers Soc Psychol 2017;113:430–52. https://doi.org/10.1037/pspi0000097.

[15] Salem V, McDonagh J, Avis E, Eng PC, Smith S, Murphy KG. Scientific medical conferences can be easily modified to improve female inclusion: a prospective study. Lancet Diabetes Endocrinol 2021;9:556–9. https://doi.org/10.1016/S2213-8587(21)00177-7.

[16] Moazzam S, Onstad L, O'Leary H, Marshall A, Osunkwo I, Du E, et al. Gender differences in question-asking at the 2019 American society of hematology annual meeting. Blood Adv 2020;4:5473–9. https://doi.org/10.1182/bloodadvances.2020002714.

[17] Dellière S, Salmona M. MicroID EmpowHERment consortium. https://microidempowerment.wordpress.com/. [Accessed 4 July 2025].

[18] Grindstaff L. Uprooting bias in the academy, lessons from the field. 2021. p. 19–44.

[19] Zimmerman DH, West C. Sex roles, interruptions and silences in conversation. In: Thomas B, Henly N, editors. Language and sex: difference and dominance; 1975. p. 105–29.

[20] Zhang J, Torchet R, Julienne H. Gender-based disparities and biases in science: an observational study of a virtual conference. PLoS One 2023;18:e0286811. https://doi.org/10.1371/journal.pone.0286811.

[21] Brescoll VL, Uhlmann EL. Can an angry woman get ahead? Psychol Sci 2007;19:268–75. https://doi.org/10.1111/j.1467-9280.2008.02079.x.

[22] Zuckerman M, Li C, Hall JA. When men and women differ in self-esteem and when they don't: a meta-analysis. J Res Pers 2016;64:34–51. https://doi.org/10.1016/j.jrp.2016.07.007.

[23] Orth U, Erol RY, Luciano EC. Development of self-esteem from age 4 to 94 years: a meta-analysis of longitudinal studies. Psychol Bull 2018;144:1045–80. https://doi.org/10.1037/bul00000161.

[24] Li J, Liu Y, Song J. The relationship between gender self-stereotyping and life satisfaction: the mediation role of relational self-esteem and personal self-esteem. Front Psychol 2022;12:769459. https://doi.org/10.3389/fpsyg.2021.769459.

[25] Wäckerle J, Silva BC. Distinctive voices: political speech, rhetoric, and the substantive representation of women in European Parliaments. Legis Stud Q 2023;48:797–831. https://doi.org/10.1111/lsq.12410.

[26] Beaman L, Chattopadhyay R, Duflo E, Pande R, Topalova P. Powerful Women: Does Exposure Reduce Bias? Q J Econ 2009;124:1497–540. https://doi.org/10.1162/qjec.2009.124.4.1497.

[27] Spencer SJ, Steele CM, Quinn DM. Stereotype threat and women's math performance. J Exp Soc Psychol 1999;35:4–28. https://doi.org/10.1006/jesp.1998.1373.

[28] Aronson J, Lustina MJ, Good C, Keough K, Steele CM, Brown J. When White men can't do math: necessary and sufficient factors in stereotypical threat. J Exp Soc Psychol 1999;35:29–46. https://doi.org/10.1006/jesp.1998.1371.

[29] Steele CM, Aronson J. Stereotype threat and the intellectual test performance of African Americans. J Pers Soc Psychol 1995;69:797–811. https://doi.org/10.1037/0022-3514.69.5.797.

[30] McKinnon M, O'Connell C. Perceptions of stereotypes applied to women who publicly communicate their STEM work. Humanit Soc Sci Commun 2020;7:160. https://doi.org/10.1057/s41599-020-00654-0.

[31] Cromer SJ, D'Silva KM, Phadke NA, Lord E, Rigotti NA, Baer HJ. Gender differences in the amount and type of student participation during in-person and virtual classes in academic medicine learning environments. JAMA Netw Open 2022;5:e2143139. https://doi.org/10.1001/jamanetworkopen.2021.43139.

[32] Nadile EM, Williams KD, Wiesenthal NJ, Stahlhut KN, Sinda KA, Sellas CF, et al. Gender differences in student comfort voluntarily asking and answering questions in large-enrollment college science courses. J Microbiol Biol Educ 2021;22:e00100-21. https://doi.org/10.1128/jmbe.00100-21.

[33] Yang Y, Tian TY, Woodruff TK, Jones BF, Uzzi B. Gender-diverse teams produce more novel and higher-impact scientific ideas. Proc Natl Acad Sci 2022;119:e2200841119. https://doi.org/10.1073/pnas.2200841119.