WCBIP 2026 · WIIP Session · Melbourne · 5 December 2026

From Challenges to Change

Women Advancing Interventional Pulmonology in Resource-Limited Settings

Dr Lamya CHRIF MORAND

Interventional Pulmonology Unit

International Hospital Kenitra

Ibn Tofail University, Kenitra, Morocco

lamya.chrif1@uit.ac.ma

Disclosure: no relevant financial relationship.

[0:55] Good morning, colleagues and friends. It is a privilege to join this session alongside women who have helped shape interventional pulmonology. Today I want to take you beyond individual career stories, and ask a broader question: what does it take for a talented woman to become an interventional pulmonologist when the training, technology, and institutional support are not readily available? This is not a talk about women as victims of circumstance. It is about women as builders of opportunity, and about the systems we must change so that excellence is not determined by geography. ---- TO CONFIRM: the disclosure line "no relevant financial relationship" and the wording WCBIP 2026 requires (same line as the sister talk). TO CONFIRM: timing. The script adds up to 18:05 for the 20 minute slot (Saturday 5 December 2026, 9:10 to 9:30), about 2 minutes of margin. Classic cover (voice note 2026-11-14): no airway rail; WCBIP 2026 lockup (logo with text, from wcbip2026.com) in the right pane, MAAB logo and WiIP Strong logo under it; university email lamya.chrif1@uit.ac.ma. The botanical emblem stays on the thanks slide. TO CONFIRM: use of the WCBIP 2026 logo on the slides (PCO wcbip2026@theconferencecompany.com). The site hero photo (Flinders Street Station) was not used: it is a Freepik stock photo, rights TO CONFIRM before any use.

The central question

Talent Is Everywhere. Opportunity Is Not.

One finds a route

A fellowship
A simulation center
Protected training time
Mentors

Same motivation, same talent.

The other builds one

Finds a trainer abroad
Pays for the travel
Negotiates time away from work
Returns to a unit without the equipment

What happens when the gender gap meets the resource gap?

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Evidence · global health

A Leadership Gap Persists

67.2%

of the global health workforce are women (2024 update)

Participation alone does not guarantee the power to decide.

67.2%: WHO, National Health Workforce Accounts, 2024 data.

WHO policy action paper: Closing the leadership gap: gender equity and leadership in the global health and care workforce. Policy action paper, June 2021. World Health Organization, Global Health Workforce Network, Women in Global Health. ISBN 978-92-4-002590-5

World Health Organization. Closing the leadership gap: gender equity and leadership in the global health and care workforce. Policy action paper. Geneva: WHO; 2021. ISBN 978-92-4-002590-5

~25%

of senior leadership roles held by women (WHO estimate, 2021 data)

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[1:10] The first layer of evidence comes from global health. According to the WHO, women account for 67.2 percent of the global health workforce in the 2024 update. Yet an earlier WHO policy analysis estimated that women occupied only around a quarter of senior roles. These estimates refer to different years and populations, so they should not be interpreted as a single contemporaneous ratio. But they illustrate a consistent pattern: participation alone does not guarantee decision-making power. This matters in procedural specialties because leaders influence who gets training, protected time, funding, and access to equipment. Evidence: WHO, Closing the Leadership Gap (2021; 2024 workforce update) ---- Fact check 2026-11-14: OK. 67.2%: WHO National Health Workforce Accounts, 2024 data (web page of the report); 25%: estimate based on data available in 2021 (report, Key messages, printed p.2). Moved from the slide (voice note 2026-11-14): "Different years and populations: not a same year ratio." Say it: the two figures come from different years and populations. Capture (Lamya's rule 2026-11-15): the WHO policy action paper as one image: its title page (title; policy action paper, June 2021; the three author organisations WHO, GHWN, WGH, iris.who.int PDF p.3) and the ISBN lines of p.4. It is the reference, so its source line was removed. The separate WHO logo was dropped: the capture shows the emblem as published. The remaining source line covers 67.2%, which comes from the WHO web page of the report (National Health Workforce Accounts, 2024 data), not from the report itself.

Women in IP survey

The Gap Is Visible Inside IP

92

physicians

47

hospitals

17

countries

Worldwide survey of physicians in IP, 2023.

PubMed record: Respiration. 2023;102(8):613-620. doi: 10.1159/000531581. Women in Interventional Pulmonology: Results from a Worldwide Survey. Judith Brock, Sonja Zehetmayer, Daniela Gompelmann

Brock J, et al. Respiration. 2023;102(8):613-20. doi:10.1159/000531581

Holding a leadership position

p = 0.002

Women23%

Men60%

Reporting gender discrimination

p = 0.023

Women26.8%

Men5.3%

Beyond encouragement: access to leadership pathways.

A small, non representative survey: no global prevalence, no causality.

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[1:20] Now look specifically at interventional pulmonology. Brock and colleagues surveyed 92 physicians in 17 countries. Among respondents, 23 percent of women versus 60 percent of men held leadership positions, a statistically significant difference. More than one in four women reported gender discrimination, compared with around one in twenty men. This was a small, nonrepresentative survey; it does not tell us the global prevalence of discrimination or establish causality. But it makes the problem visible within our own specialty. Our response must go beyond encouragement and include access to leadership pathways. Evidence: Brock J et al. Respiration. 2023;102:613–620. doi:10.1159/000531581 ---- No open item (fact check 2026-11-14: OK. Leadership 23% of women vs 60% of men, p = 0.002; discrimination 26.8% vs 5.3%, p = 0.023). Capture (Lamya's rule 2026-11-15): the user's capture of the PubMed record with journal, DOI, title and authors (research/sources/captures); it is the reference, so the citation line was removed. The publisher page (Karger) blocks automated captures.

Worldwide IP training survey
102 responses · 34 countries

A Second Divide: Access to Training

70%

report no structured IP training program in their country

41%

had no interventional exposure in general pulmonary training

96%

support a standardized global curriculum

Respondent reports from a convenience sample, not country level prevalence estimates.

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Article proof, first page: Respiration, Interventional Pulmonology, DOI: 10.1159/000552099. Worldwide Survey on Interventional Pulmonology Training Programs. Lamya Chrif Morand, Lorenzo Corbetta

Chrif Morand L, Corbetta L. Respiration. 2026. doi:10.1159/000552099

[1:20] Our worldwide survey examined 102 responses across 34 countries. Seventy percent reported that their country lacked a structured IP training program. Forty-one percent described no exposure to interventional techniques in general pulmonary training, while 96 percent supported a standardized global curriculum. These are respondent reports from a convenience sample, not country-level prevalence estimates. Nevertheless, the contrast is striking: we are rapidly advancing robotic bronchoscopy and other technologies, while many colleagues still lack a predictable route to basic procedural competence. Equity begins with education. Evidence: Chrif Morand L, Corbetta L. Respiration. 2026. doi:10.1159/000552099 · n=102, 34 countries ---- No open item (fact check 2026-11-14: OK). Capture (Lamya's rule 2026-11-15): first page of the Karger proof with journal, DOI, title and authors; the dates block ("Published online: April ▪▪▪, 2026") is left out. It is the reference, so the citation line was removed. TO ADD: the published header once Karger is reachable (Cloudflare challenge on 2026-11-14).

Worldwide survey · by region

Training Access: A North South Divide

Structured IP program in the country

North America100%

Europe31%

Asia30%

Africa0%

South America: programs only in Argentina and Brazil, of the four countries represented.

Worldwide survey: Chrif Morand L, Corbetta L. Respiration. 2026. doi:10.1159/000552099. Results, p.4; Fig. 1, p.3.

Respondents from Africa

0%

report a structured IP training program in their country

Figure 1 of the worldwide survey: countries of origin of respondents, 34 countries highlighted in blue

Fig. 1: countries of origin of the respondents (34)

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NEW SLIDE: no script text, to validate. North American (USA and Canada) respondents reported the highest prevalence of structured programs (100%), followed by Europe (31%) and Asia (30%). In South America, programs were identified only in Argentina and Brazil among the four countries represented. In contrast, respondents from Africa reported a complete absence (0%) of structured IP training programs, highlighting a critical gap in regional medical education. ---- Source: Chrif Morand L, Corbetta L. Respiration 2026 (proof), Results, Availability of Structured IP Programs, article p.4; Fig. 1 (countries of origin of respondents, 34 countries), article p.3. The paragraph above quotes the article verbatim. TO VALIDATE (Lamya): the slide and its title. The article compares regions (North America, Europe, Asia, South America, Africa); it has no income level split, so "North South" is the slide's wording, not the article's. Caution: Africa is about 12% of the 102 respondents; the article's limitations note the low statistical power of subgroup analyses "particularly for regions with fewer respondents such as Africa" (p.8). Respondent reports, not country level prevalence.

Pan-African survey · 51 respondents · 16 countries

Africa: A Measurable Capacity Gap

49%

had no structured IP training

84.6%

of those trained, trained outside Africa

Published article: The First Pan-African Survey of Interventional Pulmonology: Current Practice, Training Gaps, and Barriers. Lamya Chrif Morand, Soumia Fdil, Anita Graham, Essam Mekhaiel, Fatimata B.R. Mbaye, Jacqueline W. Kagima, Sabah A. Hussein. Journal of Bronchology and Interventional Pulmonology 33(4), October 2026. DOI: 10.1097/LBR.0000000000001087

Chrif Morand L, et al. J Bronchology Interv Pulmonol. 2026;33(4):e01087. doi:10.1097/LBR.0000000000001087

Figure 1 of the pan-African survey: respondent countries in the five African subregions

Institutional IP unit, by subregion

25 of 51

respondents (49.0%) report an IP unit

Northern75.0% 18/24

Western33.3% 4/12

Eastern12.5% 1/8

Central0.0% 0/5

Southern100% 2/2

A single international fellowship cannot be our only solution.

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[1:25] Our first pan-African survey gives us a closer view. Fifty-one interventional pulmonologists from sixteen countries participated. Forty-nine percent reported no structured training. Among those who had received structured training, 84.6 percent trained outside Africa. Only 24 percent reported radial EBUS availability. These data describe participating clinicians, not the whole continent, and they do not provide sex-stratified estimates. They are still valuable because they identify practical constraints: local training pathways, equipment, and geographic access. They show why a single international fellowship cannot be our only solution. Evidence: Chrif Morand L et al. J Bronchology Interv Pulmonol. 2026;33:e01087. doi:10.1097/LBR.0000000000001087 ---- Moved from the slide (voice note 2026-11-14, classic layout): "Participating clinicians, not the whole continent; no sex stratified estimates." and "First pan-African survey of IP, 2026." Say it: these data describe participating clinicians, not the whole continent. Radial EBUS removed from the slide (voice note 2026-11-14), so the former TO VERIFY on its denominator is obsolete. TO CONFIRM: drop the sentence "Only 24 percent reported radial EBUS availability" when speaking; if kept, say "24 percent of the 25 IP units" (the speech above stays verbatim from the script). Equipped units (new on the slide): manuscript v3 Table 1, p.7: 25 of 51 respondents (49.0%) report an institutional IP unit; Northern Africa 18 of 24 (75.0%), Western 4 of 12 (33.3%), Eastern 1 of 8 (12.5%), Central 0 of 5 (0.0%), Southern 2 of 2 (100.0%). Southern Africa rests on 2 respondents. Two different 49 percent: 49.0% have no structured IP training, and 49.0% (25 of 51) report an IP unit. Name each one clearly when speaking. Capture (Lamya's rule 2026-11-15): the published abstract page (Ovid/LWW) with title, authors, journal, issue and DOI; it is the reference, so the citation line was removed. Figure 1 of the manuscript: respondent countries, 5 subregions.

An analytical framework, not a measured effect

The Double Barrier

At the intersection: fewer routes to autonomy and leadership

Conceptual synthesis: intersectional effect not quantified in cited IP surveys.

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Gender barriers

Resource barriers

Double barrier

Gender related

Recognition
Sponsorship
Access to leadership
Unequal care responsibilities

Resource related

Limited equipment
Few training centers
High costs
Low procedural volume

[1:15] Here is the conceptual heart of this talk. On one side are gender-related barriers: recognition, sponsorship, access to leadership, and unequal care responsibilities. On the other are resource-related barriers: limited equipment, few training centers, high costs, and low procedural volume. Their intersection may make advancement harder, but we need to be precise: our existing surveys have not directly measured the interaction between gender and resource scarcity. Rather than claiming a number we do not have, let us use this framework to design the next generation of research—and the next generation of solutions. Evidence: Conceptual synthesis; intersectional effect not quantified in cited IP surveys ---- No open item. The kicker keeps the framework from reading as a measured effect. Moved from the slide (voice note 2026-11-14): "Not measured in our surveys: a framework for the next research."

The patient pathway

What Scarcity Means in Practice

Pan-African IP survey 2026: pathways illustrative, not causal estimates.

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01

Late referral

delayed diagnostic bronchoscopy

02

Travel to sample

no local advanced sampling, referral abroad

03

Limited tissue

fewer diagnostic options

04

Unequal access

patients, trainees and services

For the patient

Referred late, sent far for sampling, or facing a system without the technology.

For the young physician

No proficiency in a procedure her unit cannot perform.

[1:15] Resource constraints are not abstract. They affect patients and professionals together. A patient with a suspicious pulmonary lesion may be referred late, travel to a distant center for advanced sampling, or face a system without consistent access to the relevant technology. At the same time, a young physician cannot become proficient in a procedure that her unit cannot perform. This is why the development of women in IP is not simply a workforce question. It is connected to service delivery, diagnostic equity, and the future of thoracic care. We should be careful not to claim that these surveys prove specific delays or outcomes; they identify capacity gaps that warrant measurement. Evidence: Pan-African IP Survey 2026; pathways illustrative, not causal estimates ---- No open item. The four stations are illustrative: do not quote delays. Moved from the slide (voice note 2026-11-14): "Illustrative pathway: capacity gaps that warrant measurement, not proven delays or outcomes."

Systematic review · 91 studies

Mentorship Helps, but Is Not Enough

PubMed record: Acad Med. 2022 Mar 1;97(3):444-458. doi: 10.1097/ACM.0000000000004563. Impact of Mentoring on Academic Career Success for Women in Medicine: A Systematic Review. Mary R Shen, Emma Tzioumis, Elizabeth Andersen, Kathryn Wouk, Rebecca McCall, Winston Li, Susan Girdler, Erin Malloy

Shen MR, et al. Acad Med. 2022;97(3):444-58. doi:10.1097/ACM.0000000000004563

Mentoring is associated with career success.
Women were more likely to have no mentor.

Who opens the doors

A mentor

offers guidance

A sponsor

helps open doors

An institution

makes those doors possible to walk through

Mentoring must be structured, accessible and tied to sponsorship.

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[1:15] Mentorship is a powerful lever, but we must define what it can and cannot do. A systematic review of 91 studies in academic medicine found associations between mentorship and career success, while women were more likely to report having no mentor. These studies are not specific to interventional pulmonology or low-resource settings, and association does not establish that mentoring alone causes promotion. The practical implication is clear: mentoring must be structured, accessible, and connected to sponsorship. A mentor offers guidance. A sponsor helps open doors. An institution makes those doors possible to walk through. Evidence: Shen MR et al. Acad Med. 2022;97:444–458. doi:10.1097/ACM.0000000000004563 ---- No open item. The photo slot was removed (review 2026-11-14): the mentor, sponsor, institution ladder carries the slide. Moved from the slide (voice note 2026-11-14): "Academic medicine, not IP or low resource settings; association, not causation." Capture (Lamya's rule 2026-11-15): the user's capture of the PubMed record with journal, DOI, title and authors; it is the reference, so the citation line was removed.

WIIP as a platform for action

From Individual Mentoring to Networks

Cross border mentorship for isolated colleagues
Peer networks that make expertise visible
Research and speaking opportunities
New leaders who create opportunities locally

Measure outcomes

A new skill?

A paper?

A service?

A new mentor?

WIIP initiatives: program examples; outcome evaluation needed. Visual: Rise to Lead mentorship program, WiIP Strong.

Rise to Lead mentorship program flyer, WiIP Strong: nine mentors, among them Dr Lamya CHRIF MORAND, IP Training: The Best Way to Succeed — Rise to Lead mentorship program

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[1:10] This is where international communities such as WIIP can contribute. Cross-border mentorship connects colleagues who might otherwise remain isolated. Peer networks make expertise visible. Research collaborations and speaking opportunities build academic and professional credibility. But I want to move the conversation from participation numbers to meaningful outcomes. Did a mentee gain a new skill? Publish a paper? Establish a service? Become a mentor herself? These are the outcomes we should measure. A network becomes transformative when it develops new leaders who then create opportunities locally. Evidence: WIIP initiatives: program examples; outcome evaluation needed ---- Visual (voice note 2026-11-14): the WiIP Strong "Rise to Lead Mentorship Program" flyer, the cohort that lists Dr Lamya CHRIF MORAND as a mentor ("IP Training: The Best Way to Succeed"), from research/wcbip/photos/tunisie of the sister talk. It replaces the AABIP 2025 colleagues photo (still in the thanks collage). TO CONFIRM: WiIP Strong agrees to show the flyer (nine mentors' portraits). TO ADD before quoting any WIIP figure: verified program metrics (script note: WIIP examples are proposed mechanisms, not proven intervention outcomes).

A practical competency model

Training Should Be a Pathway, Not an Event

Training survey: Chrif Morand L, Corbetta L. Respiration. 2026.

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01

Accessible theory

case based learning

02

Simulation

before supervised patient procedures

03

Supervised practice

with a logbook

04

Objective assessment

and ongoing mentorship

PubMed record: Chest. 2023 Oct;164(4):952-962. doi: 10.1016/j.chest.2023.05.012. Effectiveness of Flexible Bronchoscopy Simulation-Based Training: A Systematic Review. Eveline C F Gerretsen, Aoben Chen, Jouke T Annema, Marleen Groenier, Erik H F M van der Heijden, Walther N K A van Mook, Frank W J M Smeenk

Gerretsen ECF, et al. Chest. 2023;164(4):952-62. doi:10.1016/j.chest.2023.05.012

Workshop with manikin and Constantina, photo to come

11 of 14

studies: simulation improved most measured outcomes

Transfer to patient performance: limited evidence.

[1:25] The next step is to build training pathways, not simply organize isolated workshops. I propose four connected components: accessible theory, simulation, supervised clinical practice with a logbook, and objective assessment. A 2023 CHEST systematic review found that eleven of fourteen studies reported positive effects of bronchoscopy simulation on most measured outcomes. However, evidence of transfer to actual patient performance remains limited. So simulation is necessary as a preparation tool, but it cannot replace supervised clinical competence. For women in resource-limited settings, structured pathways can reduce dependence on informal networks and unpredictable opportunities. Evidence: Chrif Morand & Corbetta 2026; bronchoscopy simulation review, CHEST 2023 ---- TO ADD (voice note 2026-11-14): the photo of a training workshop with a manikin and Constantina, which Lamya will send; it replaces the framed slot (244 x 140, camera mark and small caption, kept on purpose until the photo arrives; review 2026-11-14). TO CONFIRM: the spelling of the name (the Rise to Lead flyer has a Konstantina KONTOGIANNI) and her consent. Fact check 2026-11-14: 11 of 14 studies (Gerretsen ECF et al., Chest 2023, flexible bronchoscopy, novices); only four studies evaluated behavioral outcomes in the patient setting. Capture (Lamya's rule 2026-11-15): the user's capture of the PubMed record with journal, DOI, title and authors; it is the reference, so the review's citation line was removed. The training survey line stays: that article's header is not on this slide.

The hub and network model

Build Locally. Connect Globally.

Regional hubsimulation, supervised cases, assessment

Nearby hospitalslinked to the hub, regional faculty

Global partnersmentorship and quality assurance

Women design, lead, teach and evaluate.

Proposed implementation framework: not an evaluated intervention.

Regional hub

Nearby hospitals

Global partners

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A research and accountability agenda

What Should We Measure by 2030?

Disaggregated by gender, region and resource context.

Access

Who can access training: slots, travel support, equipment

Equity

Who completes it: selection, retention and leadership by gender

Competence

Who achieves independently assessed competence, with case logs

Patient impact

Referral to diagnosis time and diagnostic yield

Without measurement, good intentions remain invisible.

Proposed indicators: not validated targets; no 2030 targets claimed.

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The action agenda

Five Commitments for Our Community

None requires perfect circumstances. Each requires collaboration and leadership.

01

Invest in access to training

not just attendance at meetings

02

Create regional programs

competency based

03

Combine mentorship with sponsorship

guidance, and doors that open

04

Make women visible

as faculty, program directors and decision makers

05

Publish the data

equity metrics, training outcomes, patient outcomes

Action agenda: informed by WHO, IP surveys and mentorship literature.

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Closing message

The Future Is Built by the Doors We Open

Talent is everywhere.

Opportunity must be, too.

From isolated success stories to systems of opportunity.

Women in interventional pulmonology, group photo at AABIP 2025

The women who come next

Photo: women in IP, AABIP 2025.

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Evidence base

References

1World Health Organization. Closing the leadership gap: gender equity and leadership in the global health and care workforce. Geneva: World Health Organization; 2021. Available from: https://www.who.int/publications/i/item/9789240025905 (2024 update: 67.2%, National Health Workforce Accounts).
2Brock J, Zehetmayer S, Gompelmann D. Women in interventional pulmonology: results from a worldwide survey. Respiration. 2023;102(8):613-20. doi:10.1159/000531581
3Chrif Morand L, Corbetta L. Worldwide survey on interventional pulmonology training programs. Respiration. 2026 May 7:1-9. doi:10.1159/000552099. Epub ahead of print.
4Chrif Morand L, Fdil S, Graham A, Mekhaiel E, Mbaye FBR, Kagima JW, Hussein SA. The first pan-African survey of interventional pulmonology: current practice, training gaps, and barriers. J Bronchology Interv Pulmonol. 2026;33(4):e01087. doi:10.1097/LBR.0000000000001087
5Shen MR, Tzioumis E, Andersen E, Wouk K, McCall R, Li W, et al. Impact of mentoring on academic career success for women in medicine: a systematic review. Acad Med. 2022;97(3):444-58. doi:10.1097/ACM.0000000000004563
6Gerretsen ECF, Chen A, Annema JT, Groenier M, van der Heijden EHFM, van Mook WNKA, et al. Effectiveness of flexible bronchoscopy simulation-based training: a systematic review. Chest. 2023;164(4):952-62. doi:10.1016/j.chest.2023.05.012

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Thank you

for your attention

#SharingIsGrowing

Dr Lamya CHRIF MORAND

lamya.chrif1@uit.ac.ma

Collage: women in IP at AABIP 2025, WiIP colleagues, WCBIP 2024 opening, the interventional pulmonology team, hands on training