Challenges and Barriers to Women's Leadership in Medical Research and How to Prevent and Overcome Them.

Despite increasing participation of women in medical research, their representation in senior leadership positions remains limited. This study aimed to describe career experiences, perceived barriers, and institutional challenges reported by senior women scientists working in academic medical research in Italy. A national cross-sectional survey was conducted using a structured 33-item questionnaire administered to a selected cohort of senior medical researchers with an h-index greater than or equal to 60 working in universities and research institutes (TIWS-Top Italian Women Scientists). The questionnaire explored work-life balance, caregiving and maternity, gender-related obstacles, access to leadership roles, and perceptions of institutional support. Responses were analyzed descriptively. Eighty-two of 100 invited (82%) participants completed the questionnaire. Most respondents reported difficulties balancing professional and personal responsibilities. Satisfaction with gender equality and inclusivity in medical research was low, and most participants reported experiencing at least one gender-related obstacle during their careers. Underrepresentation of women in leadership and limited access to decision-making roles were frequent concerns. A substantial proportion of respondents (37%) have considered leaving academic medical research because of the challenges. This study provides descriptive insight into challenges affecting career progression and leadership among highly accomplished women in medical research. Based on self-reported perceptions within a selected cohort, the findings should not be considered broadly representative but highlight experiences related to work-life balance, leadership access, and institutional context. These results may support prevention of barriers and action on more inclusive and sustainable women leadership pathways.