ABSTRACT NUMBER: ESOC2026A1185 BREAKING THE GLASS CEILING IN MEDICINE: A SYSTEMATIC REVIEW OF BARRIERS AND INTERVENTIONS FOR WOMEN’S CAREER ADVANCEMENT

Abstract Background and aims Despite achieving parity among medical school graduates, women remain underrepresented in senior academic and leadership positions in medicine. This persistent gap indicates systemic barriers extending beyond individual career choices. This systematic review synthesizes contemporary evidence on barriers contributing to sex-based inequities in academic medicine and narratively evaluates interventions aimed at promoting women’s career advancement. Methods A systematic literature search was conducted in PubMed in November 2022 and updated in March 2024, following PRISMA guidelines. Eligible publications from the past 30 years, written in English or German, examined sex disparities in medical careers in developed countries. Due to substantial heterogeneity in study designs and outcome measures, quantitative synthesis was not feasible. Findings were therefore integrated using a structured narrative synthesis across individual, interpersonal, institutional, and societal levels. Results Of 1,805 records screened, 193 articles met inclusion criteria. Individual-level barriers included limited access to mentoring, impostor syndrome, and disincentives for research careers. Interpersonal barriers encompassed discrimination, sexual harassment, and exclusion from professional networks. Institutional factors included rigid career structures, incompatibility of family life and career progression, and undervaluation of teaching and clinical work. Societal influences such as sex stereotypes, implicit bias, and role incongruity for women leaders reinforced inequities. Interventions most commonly included individual-level support mechanisms, while fewer initiatives addressed institutional or policy-level reform. Conclusions The evidence confirms a persistent glass ceiling in academic medicine. While individual-focused interventions offer short-term benefits, sustainable sex equity requires comprehensive structural and institutional reforms addressing promotion criteria, academic–family role balance, and leadership norms. Conflict of interest Georgakakou: nothing to disclose; Peycheva: nothing to disclose; Berger: nothing to disclose; Goeldlin: nothing to disclose;Voigt: nothing to disclose; Christensen: nothing to disclose; Li: nothing to disclose; Antonenko: nothing to disclose;Heldner: nothing to disclose.