Gender disparities in application and admission to the medical residency program in Peru: A cross sectional study from 2016 to 2023

Daniel Medina-Neira; Brenda Caira-Chuquineyra; Daniel Fernandez-Guzman

doi:10.1371/journal.pone.0316859

Peer Review History

Original SubmissionSeptember 5, 2024
11 Oct 2024 Decision Letter - Barry Kweh, Editor PONE-D-24-38457Gender disparities in the medical residency program in Peru: an analysis of applications and admissions from 2016 to 2023.PLOS ONE Dear Dr. Fernández Guzmán, Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process. Please submit your revised manuscript by Nov 25 2024 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file. Please include the following items when submitting your revised manuscript: A rebuttal letter that responds to each point raised by the academic editor and reviewer(s). You should upload this letter as a separate file labeled 'Response to Reviewers'. A marked-up copy of your manuscript that highlights changes made to the original version. You should upload this as a separate file labeled 'Revised Manuscript with Track Changes'. An unmarked version of your revised paper without tracked changes. You should upload this as a separate file labeled 'Manuscript'. If you would like to make changes to your financial disclosure, please include your updated statement in your cover letter. Guidelines for resubmitting your figure files are available below the reviewer comments at the end of this letter. If applicable, we recommend that you deposit your laboratory protocols in protocols.io to enhance the reproducibility of your results. Protocols.io assigns your protocol its own identifier (DOI) so that it can be cited independently in the future. For instructions see: https://journals.plos.org/plosone/s/submission-guidelines#loc-laboratory-protocols. Additionally, PLOS ONE offers an option for publishing peer-reviewed Lab Protocol articles, which describe protocols hosted on protocols.io. Read more information on sharing protocols at https://plos.org/protocols?utm_medium=editorial-email&utm_source=authorletters&utm_campaign=protocols. We look forward to receiving your revised manuscript. Kind regards, Barry Kweh Academic Editor PLOS ONE Journal Requirements: 1. When submitting your revision, we need you to address these additional requirements. Please ensure that your manuscript meets PLOS ONE's style requirements, including those for file naming. The PLOS ONE style templates can be found at https://journals.plos.org/plosone/s/file?id=wjVg/PLOSOne_formatting_sample_main_body.pdf and https://journals.plos.org/plosone/s/file?id=ba62/PLOSOne_formatting_sample_title_authors_affiliations.pdf Additional Editor Comments: A well written article but a broader discussion of the limitations and potential biases inherent to specialty selection is required. A broader discussion of the comparative literature regarding gender disparities in other countries would also be valuable. [Note: HTML markup is below. Please do not edit.] Reviewers' comments: Reviewer's Responses to Questions Comments to the Author 1. Is the manuscript technically sound, and do the data support the conclusions? The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented. Reviewer #1: Yes Reviewer #2: Yes Reviewer #3: Partly Reviewer #4: Partly ******** 2. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: Yes Reviewer #2: I Don't Know Reviewer #3: Yes Reviewer #4: N/A ****** 3. Have the authors made all data underlying the findings in their manuscript fully available? The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified. Reviewer #1: Yes Reviewer #2: No Reviewer #3: Yes Reviewer #4: Yes ****** 4. Is the manuscript presented in an intelligible fashion and written in standard English? PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here. Reviewer #1: No Reviewer #2: Yes Reviewer #3: Yes Reviewer #4: Yes ****** 5. Review Comments to the Author Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters) Reviewer #1: Comments by Headings 1. General comment The authors could have used line numbers and page numbers to ease the review process. In its current form, it is difficult to point authors to specific locations for suggested corrections. 2. Abstract The abstract provides a clear overview of the study, highlighting the main findings effectively. The authors have succeeded in presenting the relevance of their research to gender disparities in medical residency applications in Peru, which is a commendable approach to addressing an underexplored topic. Suggestions for Improvement: To enhance readability, authors may consider rearranging the results to present proportions first, followed by the trend analysis, and then the measures of association. This sequence will provide a clearer flow from descriptive to inferential statistics, making it easier for readers to follow the findings. 3. Introduction The introduction does an excellent job of setting the stage by providing a thorough background on gender disparities in medical specialties. The objectives are clearly defined, and the importance of the study is well articulated. The inclusion of data from various countries to support the need for gender equity in medical specialties is particularly strong. Suggestions for Improvement: a. Clarity in Terminology: The opening sentence, "differences between individuals," could be more specific in its reference to gender-related disparities. I suggest explicitly stating that these differences pertain to unequal treatment or outcomes based on gender, to avoid ambiguity. b. References: The following statements should be supported with references: "The percentage of female physicians registered with the medical college of Peru rose from 11.5% in 1971 to 48.9% by 2011." "In the Ministry of Health and regional governments, the percentage of female doctors rose from 34.6% in 2013 to 38.6% in 2018." c. Precision in Time Statements: The expression “To date” in the last paragraph needs to specify the year, as it currently lacks clarity. For example, “As of [year],” will enhance temporal specificity. 4. Methods The authors’ choice of using a multilevel model to assess gender disparities across medical specialties is a robust approach. It accounts for variations between specialties and time periods, which adds rigor to the analysis. Suggestions for Improvement: a. Gender Classification: The binary classification of gender (male and female) does not account for non-cisgender individuals, which could potentially skew the results. I suggest the authors acknowledge this limitation and discuss how the inclusion of non-binary or transgender categories could affect the study’s findings. b. Outcome and Independent Variables: The structure of the methods section could benefit from a clearer organization. I recommend introducing the outcome and independent variables explicitly under a separate subsection before diving into detailed explanations. 5. Results The results section presents a comprehensive analysis of trends in female participation in medical residency programs. The use of percentages and graphs enhances understanding of gender disparities, and the breakdown by specialty provides valuable insights. Suggestions for Improvement: a. Time Period Wording: The phrase "Between 2016 and 2023" should be revised to "From 2016 to 2023" for clarity and accuracy, as it better reflects the inclusion of both years in the data. b. Relocation of Explanations: The explanation for the observed application rate drop in 2020 and 2021 could be better placed in the discussion section, where the impact of external factors like the COVID-19 pandemic can be explored in depth. c. Table 1 Descriptions: To improve clarity, I recommend either providing a descriptive summary of each specialty in Table 1. If the authors intend to use groupings (medical, laboratory-diagnostic, medical-surgical) as they have, they should provide a key below the table to explain what the groupings represent. d. Subheadings: The inclusion of subheadings in the results section would greatly enhance the clarity and organization of the section, especially considering the detailed nature of the findings. e. Graph Titles: For the graphs, I recommend that the authors review the PLOS ONE submission guidelines on presenting graph titles and improve the graph titles. This will help readers quickly grasp the key points/legends when looking at the figures. f. Consistency in Statistical Models: Consistency in Statistical Models: The model described in the methods section for measuring the association is multilevel Poisson regression, while the model in the results section is a generalized linear mixed-effects model. I recommend that the authors use consistent terminology to avoid confusion for the reader. 6. Discussion The discussion does well to contextualize the findings within the broader literature and highlight gender disparities in medical specialties, particularly in surgical fields. The comparison with international studies strengthens the relevance of the findings. Suggestions for Improvement: a. When discussing the proportion of women admitted to specialties, it would be beneficial to expand beyond the year 2016. Since data from 2016–2023 is available, a broader temporal analysis will provide a more comprehensive understanding of trends and fluctuations over time. b. Addressing Gender Imbalance: The authors could provide a more detailed exploration of potential solutions to gender imbalances, particularly in surgical specialties. This would elevate the discussion by not only identifying disparities but also suggesting actionable interventions, such as mentorship programs, policies, or structural changes in medical training environments. c. Limitation on Gender Categorization: While the discussion acknowledges limitations, the binary gender classification should be discussed more critically. Addressing how this might exclude or marginalize non-binary individuals would show a broader inclusivity in the analysis. Conclusion The paper addresses an important gap in the literature on gender disparities in medical residency programs in Peru and offers valuable insights that will contribute to the field. With some refinement in the clarity of methods, results, and expansion in the discussion, this manuscript will make a strong contribution to the conversation on gender equity in medicine. Reviewer #2: Results - Page 13: Perhaps elaborate on what specifically during the pandemic in 2020 to 2021 prevented the increase in applicants (financial costs, pause in schooling, illness?). Discussion - Page 18: Perhaps add a sentence elaborating on the "institutional and governmental policies promoting equal opportunities" in Peru, as those from outside the country may not be aware of the policies. Figures - May be nice to include a bar graph comparing male and female admission of all specialties for a quick visual representation of the results. References - May be good to double check reference style as some journal names are abbreviated (36, 40, 41) while others aren't (33, 43) etc. Reviewer #3: This study addresses a significant issue (Gender disparities in the medical residency program in Peru), providing a detailed analysis of trends over time and across medical specialties. The study has an explanatory introduction, a review of relevant literature, and a thorough explanation of the methodology. In the discussion part, the authors acknowledge that inferring the applicants gender based on their first names, using a binary gender classification, and excluding 2.4% of applicants limit the generalizability of their findings. However, there are areas where the manuscript could be improved: 1- The study states that the application process is based on a numerical scoring system, in order to conclude more precisely that there is a gender disparity in the admissions, there should be a reference to the average score of each gender group ( or referring to its impact in the limitation part), and an explanation on the possible impact of gender on this scoring system. 2- The study mentions that women tend to apply more to certain specialties, where admission rates may be more competitive. A disparity in specialty selection could skew the overall admission rates for women if certain specialties are more difficult to enter. It is essential to address the total application and admission rate by specialty to provide a more accurate picture. 3- The study mentions that some data were excluded. However, it’s unclear if the authors conducted a sensitivity analysis to check whether the exclusion of this data affects the overall results. Reviewer #4: While the manuscript is sound, the data can only partially support the conclusions. as stated in the research limitations, the sex of participants was made based on inferences from the name which by default lowers the accuracy. As such it will affect the significance of the study's findings. In addition, the title of the research does not elaborate well on what has been done and I recommend including the type of study applied in the title. on the abstract the first sentence of methods seems like a repetition of the objective written in different words. Instead, I recommend describing the type of study design used as an introduction to the method just like what is written in the methods part on the full article. on the introduction, you have used outdated references that were dated more than 15 years back such as reference no. 9, I recommend removing them and finding new references. In addition, little information given on global perspective distribution of gender across various medical specialties. it will be better to add more research papers. when it comes to methods part, I believe the source of the data used for the study is inadequate. I would recommend getting the names of the applicants and correlating it with the universities record for more detailed information such as sex of participants. The other thing is I do not believe the study has exhausted in researching independent variables which may affect the result of study. The only independent variable included in the study is the year of study while variables such as financial status or Admission Requirement status of the participants have not been touched. such confounding variables must first be addressed before concluding that there is gender disparity in the admission for medical residency program. on the result section on the sociodemographic data instead of putting a single year's data on the table I recommend using range or overall average to include other years emphasizing on years with highest female. the range or overall average result should also be used in abstract so that the abstract information will not be misleading. In addition, model assumption or model adequacy tests done for regression have not been mentioned, this should be included as part of the result. Overall the research has a good start but as stated in the limitations needs more work on it to reach into an accurate conclusion ****** 6. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files. If you choose “no”, your identity will remain anonymous but your review may still be made public. Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy. Reviewer #1: No Reviewer #2: No Reviewer #3: No Reviewer #4: Yes: Dr. Anteneh A. Beyene ******** [NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.] While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org. Please note that Supporting Information files do not need this step. https://doi.org/10.1371/journal.pone.0316859.r001
Revision 1
11 Nov 2024 Author Response "See the response to comments in the file 'Response to Reviewers'." Reviewer Comments Response #1 The authors could have used line numbers and page numbers to ease the review process. In its current form, it is difficult to point authors to specific locations for suggested corrections. We appreciate your comment. We have added line numbers and page numbers. #1 The abstract provides a clear overview of the study, highlighting the main findings effectively. The authors have succeeded in presenting the relevance of their research to gender disparities in medical residency applications in Peru, which is a commendable approach to addressing an underexplored topic. Suggestions for Improvement: To enhance readability, authors may consider rearranging the results to present proportions first, followed by the trend analysis, and then the measures of association. This sequence will provide a clearer flow from descriptive to inferential statistics, making it easier for readers to follow the findings. We appreciate your comment. The following order of results presentation has been followed in the summary: descriptive and trend results of applicants, followed by those of admitted students. #1 The introduction does an excellent job of setting the stage by providing a thorough background on gender disparities in medical specialties. The objectives are clearly defined, and the importance of the study is well articulated. The inclusion of data from various countries to support the need for gender equity in medical specialties is particularly strong. Suggestions for Improvement: a. Clarity in Terminology: The opening sentence, "differences between individuals," could be more specific in its reference to gender-related disparities. I suggest explicitly stating that these differences pertain to unequal treatment or outcomes based on gender, to avoid ambiguity. b. References: The following statements should be supported with references: "The percentage of female physicians registered with the medical college of Peru rose from 11.5% in 1971 to 48.9% by 2011." "In the Ministry of Health and regional governments, the percentage of female doctors rose from 34.6% in 2013 to 38.6% in 2018." c. Precision in Time Statements: The expression “To date” in the last paragraph needs to specify the year, as it currently lacks clarity. For example, “As of [year],” will enhance temporal specificity We appreciate your comment. a. We have modified the opening sentence to be more specific about gender-related differences. We modified the "Introduction" section in lines 62-63 to clarify what was done: “Disparities among individuals due to gender inequality across various domains such as the economy [1], education [2], and health [3]”. b. We supported the mentioned statements with respective references. We modified the "Introduction" section in lines 75-76, by adding the references. c. We replaced it with a more specific time expression. We modified the "Introduction" section in line 84 to clarify what was done: “Up to 2024, no study has assessed gender disparities in the application and admission processes for various medical specialties in Peru” #1 The authors’ choice of using a multilevel model to assess gender disparities across medical specialties is a robust approach. It accounts for variations between specialties and time periods, which adds rigor to the analysis. Suggestions for Improvement: a. Gender Classification: The binary classification of gender (male and female) does not account for non-cisgender individuals, which could potentially skew the results. I suggest the authors acknowledge this limitation and discuss how the inclusion of non-binary or transgender categories could affect the study’s findings. b. Outcome and Independent Variables: The structure of the methods section could benefit from a clearer organization. I recommend introducing the outcome and independent variables explicitly under a separate subsection before diving into detailed explanations. We appreciate your comment. a. We added this limitation in the corresponding section of the article and we discuss how inclusion of non-binary categories could affect the study results. We modified the " Limitations and Strengths" section in lines 319-326 to clarify what was done: “Third, our findings are limited by the use of binary gender categories, as we lack information on the gender identity of each applicant. The collection of this information is not included in the options for this non-anonymized database. This may limit the generalizability of the results to populations with diverse gender identities. The implications of excluding non-binary gender from our analysis may result in alterations to the observed trends for women in certain medical specialties. Nevertheless, the estimated prevalence of potential non-binary applicants to medical residency programs is likely to be less than 5%, suggesting that any variations in gender frequency may not be substantial”. b. A paragraph was added in the Methods section clarifying the variables used for trend analysis. Additionally, the outcome and independent variables used for the association analysis were specified. We modified the "Variables" section in lines 97-100, to clarify what was done: “We constructed the gender variable, based on applicants' names recorded in the database for the medical residency program in Peru, since gender information was not explicitly provided in the application process” and in lines 110-114, to clarify what was done: “For the trend analysis, the percentage of females among the applicants and those admitted to the medical residency program in Peru was considered, with these variables being of an ecological level. Finally, for the association analysis, the dependent variable was the admission outcome to the medical residency program, and the independent variable was the applicant's gender (female vs. male).” #1 The results section presents a comprehensive analysis of trends in female participation in medical residency programs. The use of percentages and graphs enhances understanding of gender disparities, and the breakdown by specialty provides valuable insights. Suggestions for Improvement: a. Time Period Wording: The phrase "Between 2016 and 2023" should be revised to "From 2016 to 2023" for clarity and accuracy, as it better reflects the inclusion of both years in the data. b. Relocation of Explanations: The explanation for the observed application rate drop in 2020 and 2021 could be better placed in the discussion section, where the impact of external factors like the COVID-19 pandemic can be explored in depth. c. Table 1 Descriptions: To improve clarity, I recommend either providing a descriptive summary of each specialty in Table 1. If the authors intend to use groupings (medical, laboratory-diagnostic, medical-surgical) as they have, they should provide a key below the table to explain what the groupings represent. d. Subheadings: The inclusion of subheadings in the results section would greatly enhance the clarity and organization of the section, especially considering the detailed nature of the findings. e. Graph Titles: For the graphs, I recommend that the authors review the PLOS ONE submission guidelines on presenting graph titles and improve the graph titles. This will help readers quickly grasp the key points/legends when looking at the figures. f. Consistency in Statistical Models: Consistency in Statistical Models: The model described in the methods section for measuring the association is multilevel Poisson regression, while the model in the results section is a generalized linear mixed-effects model. I recommend that the authors use consistent terminology to avoid confusion for the reader. We appreciate your comment. a. We replaced the time period wording. We modified the "Results" section in line 153-154 to clarify what was done: “From 2016 to 2023, a total of 49,213 individuals applied for medical residency programs” b. We added an explanation for the application rate drop during the COVID-19 pandemics and we placed it in the discussion section. We modified the "Discussion" section in lines 289-294 to clarify what was done: “Another significant finding was the year-on-year increase in the number of applicants, with the exception of 2020 and 2021, likely due to the COVID-19 pandemic. The pandemic reduced medical residency applicants in Peru due to several factors. Financial challenges and economic instability, the interruptions in medical education from suspension of clinical training and the health risks associated with COVID-19, both for potentials applicants and their families, created emotional and physical stress that influenced some to defer their medical specialization plans.” c. We provide a key below the table to provide a descriptive summary of each specialty. We modified the "Results" section in line 170 to clarify what was done: “”. e. We have corrected the label and title size according to the journal suggestions. We modified the "Results" section in line 184-185 and 197-198 to clarify what was done: “Fig 1. Trends in Female Applicants to Medical Residency Programs in Peru, 2016–2023” and “Fig 2. Trends in Female Admissions to Medical Residency Programs in Peru, 2016–2023”. f. We used a consistent terminology to describe the used methods for measuring the association. We modified the "Results" section in line 200 to clarify what was done: “We used a multilevel Poisson regression model, with specialties as random intercept and slope variables, to assess the association between sex and admission to a medical residency program.”, and in lines 207-208 to clarify what was done: “Table 2: Association between gender and admission to a medical residency program using multilevel Poisson regression models” #1 The discussion does well to contextualize the findings within the broader literature and highlight gender disparities in medical specialties, particularly in surgical fields. The comparison with international studies strengthens the relevance of the findings. Suggestions for Improvement: a. When discussing the proportion of women admitted to specialties, it would be beneficial to expand beyond the year 2016. Since data from 2016–2023 is available, a broader temporal analysis will provide a more comprehensive understanding of trends and fluctuations over time. b. Addressing Gender Imbalance: The authors could provide a more detailed exploration of potential solutions to gender imbalances, particularly in surgical specialties. This would elevate the discussion by not only identifying disparities but also suggesting actionable interventions, such as mentorship programs, policies, or structural changes in medical training environments. c. Limitation on Gender Categorization: While the discussion acknowledges limitations, the binary gender classification should be discussed more critically. Addressing how this might exclude or marginalize non-binary individuals would show a broader inclusivity in the analysis. Conclusion The paper addresses an important gap in the literature on gender disparities in medical residency programs in Peru and offers valuable insights that will contribute to the field. With some refinement in the clarity of methods, results, and expansion in the discussion, this manuscript will make a strong contribution to the conversation on gender equity in medicine. We appreciate your comment. a. No data on the results of those admitted to the medical residency program in Peru is available for years prior to the 2016–2023 period. Consequently, data from applicants before 2016 were not included in our study’s analysis. This limitation is noted in the Strengths and Limitations section of the Discussion. b. We have expanded the discussion to address the gender imbalance in applicants and those admitted to surgical specialties with the respective suggestions for implementing interventions. We modified the "Discussion" section in lines 252-258 to clarify what was done: “To address the gender imbalance in surgical residency programs, it is essential to implement interventions such as mentorship programs that provide support and networking opportunities for female residents. Additionally, adopting gender equity policies, such as extended maternity leaves and impartial selection processes, can help eliminate barriers faced disproportionately by women. Finally, making structural changes within the residency program, such as offering flexible schedules and robust institutional support, is crucial to facilitating work-life balance, particularly in specialties with low female representation”. c. We have expanded on the implications of excluding non-binary individuals in the limitations section of the discussion. We modified the "Limitations and Strengths" section in lines 319-326 to clarify what was done: “Third, our findings are limited by the use of binary gender categories, as we lack information on the gender identity of each applicant. The collection of this information is not included in the options for this non-anonymized database. This may limit the generalizability of the results to populations with diverse gender identities. The implications of excluding non-binary gender from our analysis may result in alterations to the observed trends for women in certain medical specialties. Nevertheless, the estimated prevalence of potential non-binary applicants to medical residency programs is likely to be less than 5%, suggesting that any variations in gender frequency may not be substantial”. Reviewer Comments Response #2 Results - Page 13: Perhaps elaborate on what specifically during the pandemic in 2020 to 2021 prevented the increase in applicants (financial costs, pause in schooling, illness?). We appreciate your comment. We add an explanation on what prevented the increase in applicants during the pandemic in the discussion section. We modified the "Discussion" section in lines 289-294 to clarify what was done: “Another significant finding was the year-on-year increase in the number of applicants, with the exception of 2020 and 2021, likely due to the COVID-19 pandemic. The pandemic reduced medical residency applicants in Peru due to several factors. Financial challenges and economic instability, the interruptions in medical education from suspension of clinical training and the health risks associated with COVID-19, both for potentials applicants and their families, created emotional and physical stress that influenced some to defer their medical specialization plans.” #2 Discussion - Page 18: Perhaps add a sentence elaborating on the "institutional and governmental policies promoting equal opportunities" in Peru, as those from outside the country may not be aware of the policies. We appreciate your comment. We add a sentence explaining those institutional and governmental policies in Peru in the discussion section. We modified the "Discussion" section in lines 229-236 to clarify what was done: “This phenomenon can be attributed to several factors, including increased availability of female role models in various specialties, changes in social perceptions of women's roles in medicine and institutional and governmental policies promoting equal opportunities [33,34]. In Peru, the Law on Equal Opportunities between Women and Men (Law No. 28983) ensures equality in rights, opportunities, and resources across areas like education, economy, and politics. Furthermore, the National Policy on Gender Equality (PNIG), led by the Ministry of Women and Vulnerable Populations, sets key goals to reduce gender disparities across various sectors”. #2 Figures - May be nice to include a bar graph comparing male and female admission of all specialties for a quick visual representation of the results. We appreciate your comment. We believe that the trend graph displaying the proportion of females in each specialty enables us to infer the proportion of males, as gender is represented as a dichotomous variable in our study. #2 References - May be good to double check reference style as some journal names are abbreviated (36, 40, 41) while others aren't (33, 43) etc. We appreciate your comment. We standar Attachments Attachment Submitted filename: 01-11 Response to reviewers.docx https://doi.org/10.1371/journal.pone.0316859.r002
29 Nov 2024 Decision Letter - Barry Kweh, Editor PONE-D-24-38457R1Gender disparities in application and admission to the medical residency program in Peru: a cross sectional study from 2016 to 2023PLOS ONE Dear Dr. Fernández Guzmán, Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process. Please submit your revised manuscript by Jan 13 2025 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file. Please include the following items when submitting your revised manuscript: A rebuttal letter that responds to each point raised by the academic editor and reviewer(s). You should upload this letter as a separate file labeled 'Response to Reviewers'. A marked-up copy of your manuscript that highlights changes made to the original version. You should upload this as a separate file labeled 'Revised Manuscript with Track Changes'. An unmarked version of your revised paper without tracked changes. You should upload this as a separate file labeled 'Manuscript'. If you would like to make changes to your financial disclosure, please include your updated statement in your cover letter. Guidelines for resubmitting your figure files are available below the reviewer comments at the end of this letter. If applicable, we recommend that you deposit your laboratory protocols in protocols.io to enhance the reproducibility of your results. Protocols.io assigns your protocol its own identifier (DOI) so that it can be cited independently in the future. For instructions see: https://journals.plos.org/plosone/s/submission-guidelines#loc-laboratory-protocols. Additionally, PLOS ONE offers an option for publishing peer-reviewed Lab Protocol articles, which describe protocols hosted on protocols.io. Read more information on sharing protocols at https://plos.org/protocols?utm_medium=editorial-email&utm_source=authorletters&utm_campaign=protocols. We look forward to receiving your revised manuscript. Kind regards, Barry Kweh Academic Editor PLOS ONE Journal Requirements: Please review your reference list to ensure that it is complete and correct. If you have cited papers that have been retracted, please include the rationale for doing so in the manuscript text, or remove these references and replace them with relevant current references. Any changes to the reference list should be mentioned in the rebuttal letter that accompanies your revised manuscript. If you need to cite a retracted article, indicate the article’s retracted status in the References list and also include a citation and full reference for the retraction notice. Additional Editor Comments: The authors have satisfactorily restructured their manuscript, broadened their discussion and clarified methodological strategy. Some proof reading and grammatical correction would significantly improve the quality and readability of the manuscript. [Note: HTML markup is below. Please do not edit.] [NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.] While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org. Please note that Supporting Information files do not need this step. https://doi.org/10.1371/journal.pone.0316859.r003
Revision 2
11 Dec 2024 Author Response Attached are the answers in the document “answers to reviewers”. Attachments Attachment Submitted filename: V2 Response to reviewers.docx https://doi.org/10.1371/journal.pone.0316859.r004
17 Dec 2024 Decision Letter - Barry Kweh, Editor Gender disparities in application and admission to the medical residency program in Peru: a cross sectional study from 2016 to 2023 PONE-D-24-38457R2 Dear Dr. Guzman, We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements. Within one week, you’ll receive an e-mail detailing the required amendments. When these have been addressed, you’ll receive a formal acceptance letter and your manuscript will be scheduled for publication. An invoice will be generated when your article is formally accepted. Please note, if your institution has a publishing partnership with PLOS and your article meets the relevant criteria, all or part of your publication costs will be covered. Please make sure your user information is up-to-date by logging into Editorial Manager at Editorial Manager® and clicking the ‘Update My Information' link at the top of the page. If you have any questions relating to publication charges, please contact our Author Billing department directly at authorbilling@plos.org. If your institution or institutions have a press office, please notify them about your upcoming paper to help maximize its impact. If they’ll be preparing press materials, please inform our press team as soon as possible -- no later than 48 hours after receiving the formal acceptance. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information, please contact onepress@plos.org. Kind regards, Barry Kweh Academic Editor PLOS ONE Additional Editor Comments (optional): The authors have broadened their discussion, clarified their methodology and improved their consistency of description of the relevant groups in questions (male/female) throughout the manuscript. Reviewers' comments: https://doi.org/10.1371/journal.pone.0316859.r005
Formally Accepted
20 Dec 2024 Acceptance Letter - Barry Kweh, Editor PONE-D-24-38457R2 PLOS ONE Dear Dr. Fernandez-Guzman, I'm pleased to inform you that your manuscript has been deemed suitable for publication in PLOS ONE. Congratulations! Your manuscript is now being handed over to our production team. At this stage, our production department will prepare your paper for publication. This includes ensuring the following: * All references, tables, and figures are properly cited * All relevant supporting information is included in the manuscript submission, * There are no issues that prevent the paper from being properly typeset If revisions are needed, the production department will contact you directly to resolve them. If no revisions are needed, you will receive an email when the publication date has been set. At this time, we do not offer pre-publication proofs to authors during production of the accepted work. Please keep in mind that we are working through a large volume of accepted articles, so please give us a few weeks to review your paper and let you know the next and final steps. Lastly, if your institution or institutions have a press office, please let them know about your upcoming paper now to help maximize its impact. If they'll be preparing press materials, please inform our press team within the next 48 hours. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information, please contact onepress@plos.org. If we can help with anything else, please email us at customercare@plos.org. Thank you for submitting your work to PLOS ONE and supporting open access. Kind regards, PLOS ONE Editorial Office Staff on behalf of Dr. Barry Kweh Academic Editor PLOS ONE https://doi.org/10.1371/journal.pone.0316859.r006

Open letter on the publication of peer review reports

PLOS recognizes the benefits of transparency in the peer review process. Therefore, we enable the publication of all of the content of peer review and author responses alongside final, published articles. Reviewers remain anonymous, unless they choose to reveal their names.

We encourage other journals to join us in this initiative. We hope that our action inspires the community, including researchers, research funders, and research institutions, to recognize the benefits of published peer review reports for all parts of the research system.

Learn more at ASAPbio .