GENDER BALANCE ACROSS EUROPEAN COUNTRIES: NARRATIVE MEDICINE ANALYSIS OF THE SURVEY FROM THE WOMEN OF ERA (WERA) TASK FORCE

The growing number of women in medicine has not translated into equal representation in leadership roles across most specialties, including nephrology. Women of the ERA (WERA) Task Force aims to raise awareness of gender balance in nephrology, create safer workplaces and inspire female nephrologists to actively engage in research, education, mentorship and official panels. To address these goals, WERA developed a survey to examine gender disparities among the ERA members. Narrative medicine is a qualitative methodology that systematically analyzes personal accounts to identify thematic patterns, emotional content, and subjective meanings attributed to professional experiences. We used it in the present analysis to capture subjective experiences and perceptions of gender balance among respondents.

We designed a 29-item questionnaire based on validated instruments addressing gender-related aspects in medicine, refined with input from a statistician and psychologist. The final questionnaire was obtained following verification with a pilot phase. The survey covered six domains: professional background, workplace environment, leadership, work-life balance, discrimination, and impostor syndrome (IPSS-3 scale). To assess the role of cultural, social and religious aspects among respondents, for each country we calculated the Human Development Index, the life expectancy, the education index, the Gross Domestic Product per capita and the predominant religion.

The survey included open-ended text fields capturing personal narratives. We analyzed them using narrative medicine techniques (search for recurrent narrative themes and thematic patterns; language use and emotional tone; lived experience and subjective meaning-making; identity construction in relation to gender; and relational dynamics with colleagues, patients, and institutions) with artificial intelligence supported qualitative coding. Artificial intelligence analysis was performed using Claude Sonnet 4.5 (Anthropic, USA).

Among 925 ERA nephrologists, 67% were women. The mean age of the respondents was 46±11 years, range 25-75; women aged 25-34 were 77.8% of nephrologists but only 40.4% of those over 65.

Women reported gender-based discrimination nearly three times more often than men (25% vs 9%) and provided longer, more emotionally nuanced narratives. Notably, in the 45-54 age group, men were 23 times more likely than women to report that gender has "no impact" on career. Motherhood and family responsibilities were the most frequently cited barriers (97 mentions by women, 41 by men), described as structural mechanisms of discrimination rather than simple time constraints, affecting even women without children. With 67 mentions in the narratives on barriers (vs 15 among men), work-life balance emerges as a constant narrative tension in women’s stories.  

Higher Human Development Index of the respondent country correlated with longer, more reflective narratives, suggesting that greater socioeconomic development enhances articulation of persistent inequities rather than eliminating them. Qualitative analysis revealed consistent themes: restricted access to leadership, inadequate mentorship, and entrenched institutional gender bias.

This large-scale survey shows substantial gender disparities in European nephrology, with marked divergence between men's and women's perceptions across all career stages. In this analysis we explored the potential of AI-assisted analysis in the field of narrative medicine. Given that this methodology is not a validated tool for narrative medicine, these results should be considered exploratory. Further analysis using manual coding and the traditional techniques of narrative medicine will provide methodological rigor and deeper insight into subjective gender experiences within the European nephrological community.