Gender bias in text-to-image generative artificial intelligence when representing cardiologists

Introduction: While the global medical graduate and student population is approximately 50% female, only 13–15% of cardiologists and 20–27% of training fellows in cardiology are female. The potentially transformative use of text-to-image generative artificial intelligence (AI) could improve promotions and professional perceptions. In particular, DALL-E 3 offers a useful tool for promotion and education, but it could reinforce gender and ethnicity biases. Method: Responding to pre-specified prompts, DALL-E 3 via GPT-4 generated a series of individual and group images of cardiologists. Overall, 44 images were produced, including 32 images that contained individual characters and 12 group images that contained between 7 and 17 characters. All images were independently analysed by three reviewers for the characters’ apparent genders, ages, and skin tones. Results: Among all images combined, 86% (N = 123) of cardiologists were depicted as male. A light skin tone was observed in 93% (N = 133) of cardiologists. The gender distribution was not statistically different from that of actual Australian workforce data (p = 0.7342), but this represents a DALL-E 3 gender bias and the under-representation of females in the cardiology workforce. Conclusions: Gender bias associated with text-to-image generative AI when using DALL-E 3 among cardiologists limits its usefulness for promotion and education in addressing the workforce gender disparities.