[Female doctors in orthopedics and trauma surgery in Germany: a current status quo]

[Controversies in promoting young talent in orthopedics and trauma surgery]

BACKGROUND

The field of orthopedics and trauma surgery is facing a serious shortage of new talent due to the increasing average age of active surgeons and a growing need for staff. The appeal of these specialties is declining among medical students.

SOLUTIONS

This trend could be reversed by introducing practice-oriented curricula, mentoring programs, and early integration into professional societies. The quality of surgical education, especially bedside teaching, needs to be improved, as it is often compromised by a lack of time and insufficient pedagogical training of the educators. The practical year (PY) is crucial to attract students to these specialties, but data indicate that the quality of training in orthopedics and trauma surgery is inferior compared to other fields. Professional societies could enhance junior development through targeted programs. Moreover, the problem of recruitment is compounded by imbalanced gender ratios and working conditions that do not align with modern family models or efficient surgical training. There needs to be a rethinking of work scheduling and task distribution in surgery to make the profession more attractive and to ensure the quality of training.

[Current approach in the follow-up treatment of joint-preserving operations on the knee joint in German-speaking countries]

INTRODUCTION

Postoperative follow-up after joint-preserving knee surgery involves conventional physiotherapy as well as other approaches and devices such as CPM and CAM splints, TENS devices, BFR exercise, prehabilitation, and digital health applications. The aim of this survey was to investigate current standards, trends and control methods in postoperative care to identify fields of concern and to compare them with the current literature.

MATERIAL AND METHODS

We conducted a structured anonymous online survey of specialists in orthopaedics and trauma surgery listed by the German-speaking Society for Arthroscopy and Joint Surgery (AGA). The questionnaire included 36 closed-ended questions on the follow-up of joint-preserving surgery of the knee joint.

RESULTS

Questionnaires from 528 participants with long-term professional experience (86.6% with more than 10 years) were analysed. Standardised post-treatment schemes are used by 97.2% and their evidence is estimated to be high (59.1%) / very high (14.8%). Problems of rehabilitation are seen in 10-20% of cases by 87.3% (persistent muscular atrophy 30.9%). After reconstructive surgery, CPM splints (70.1%), CAM splints (42.1%), orthoses (85.0%) and TENS devices (40.0%) are prescribed. More potent approaches for the treatment of postoperative muscle deficits are desired by 89.4%. BFR exercise is known by 41.7% and is used regularly by 8%. Communication with treating physiotherapists is infrequent (written: 27.5%). Digital rehabilitation management would be supported by 83.3%; 22.7% are not aware of digital health applications. 87.9% of participants believe that prehabilitation can affect postoperative outcomes.

CONCLUSION

Follow-up of knee joint-preserving surgeries is usually standardised and regularly reviewed for up-to-date evidence. The evidence for recommendations made is considered high. Orthoses are usually used after reconstructive surgery, persistent muscle atrophy is a major problem, BFR training is only known to a limited extent, and there is currently a lack of standardised training protocols. Communication with physiotherapists needs to be improved. Digital rehabilitation management is rarely used but would be supported by the majority of surgeons.

[What female surgeons wish for!]

BACKGROUND

Surgical specialties have a recruitment problem. A magnification of the problem is often seen in the "feminization" of medicine but the causes are multifactorial. Female physicians of the association "Die Chirurginnen e. V." want to raise enthusiasm for their profession and strengthen the affinity for a surgical specialty by increasing the visibility and networking of female surgeons. The aim of this article is to present the results of a survey among female surgeons and to discuss them in the focus of the current shortage of personnel.

METHODOLOGY

An anonymized online survey was conducted internally within the association ("Die Chirurginnen e. V.") in October 2022. The survey contained a total of 57 questions and was divided into 7 sections (demographic data, questions about wishes in professional life, private life, social life, towards professional associations, politics and the association). Descriptive statistics were used for the analysis.

RESULTS

A total of 358 female surgeons participated in the survey. This represented a response rate of 25.5% of association members (as of October 2022: n = 1406). The mean age was 39.25 years (±8.06 years; range 25-65 years), 37% (n = 133) were in the specialty of orthopedic and trauma surgery and 26% (n = 93) were in the specialty of visceral surgery. The remainder were distributed across a variety of different surgical specialties. The desire for change was preferentially in the area of continuing surgical education, the implementation of working time models, and the organization of the personal workday (operating room time, administrative tasks, time for patients, bureaucracy).

DISCUSSION

Motivated and dedicated surgeons are needed to counteract the already existing and increasingly severe shortage of manpower. In recent decades, the proportion of female students and physicians has been increasing, so the needs for recruitment must be increasingly considered. The disparity between men and women at the management level must be gradually resolved. In addition, alternative working models for both genders need to be established in daily practice. By providing a good compatibility of family/private life and career, surgery can remain an attractive profession for future generations.

Bibliometric Analysis of Research Areas, Publication Hierarchy and Gender Authorship in German University Orthopaedic Surgery

BACKGROUND

The aim of the present bibliometric study was to record the focus of publications, type of study and publication activities depending on the hierarchy level and gender of the authors of German university departments for orthopaedic surgery.

MATERIAL AND METHODS

The publication performance of the staff surgeons, consisting of chief and senior physicians, section and division heads of 39 German university departments of orthopaedic surgery university hospitals, was recorded over a period of 10 years (January 1, 2010 to December 31, 2019). All publications were considered that were listed in PubMed and for which the staff surgeons were first or last authors. In addition, the impact factor (IF) and the h-index were determined.

RESULTS

1739 (39.2%) publications were compiled by 180 staff surgeons of university departments for trauma surgery and 2699 (60.8%) publications by 343 surgeons in departments of orthopaedics and trauma surgery. Most publications were related to injuries or impairments of the lower extremity including the hip (n = 1626; 38.1%), followed by the upper extremity (n = 737; 17.3%). These publications focussed on diagnostic testing (25.5%), surgical techniques (19.1%) or special osteosyntheses (16.9%). The highest average IF per publication was achieved by publications on plastics (IF 2.02), on outcome (IF 1.96) and on diagnostic testing (IF 1.93). Heads of departments were first authors in 18.8%, senior physicians with management functions in 40.7% and senior physicians without management functions in 69% of papers and last authors in 81.2%, 49.3% and 31.0% of articles, respectively. 64 of 523 staff surgeons (12.2%) were women. 306 authors (6.1%) were women, corresponding to 4.8 authorships per female surgeon - significantly for male surgeons (10.3 authorships per male surgeon).

CONCLUSION

In the present study, among senior physicians with a management function, the share of publishing surgeons was 59.1% for women, but 85.5% for men. In contrast, in the group of senior physicians without management function female and male surgeons were almost equally represented (57.5% vs. 60.5%). It must therefore be asked whether the work life balance is more difficult to meet for women than for men with longer careers. Mentoring programs are required to support the publication activities of the increasing number of female applicants in the future.

[What explains the "gendered reputation" of residency subjects? : Reasons for gendered specialty selection and careers in spine-surgery residency programs-compared to a "female" specialty]

BACKGROUND

Currently, the proportion of women in academic education and residency is predominant, but specialty-specific distribution of leading positions is partly reciprocal (orthopedics/surgery). Are there any differences that indicate a gender-dependent redistribution in leadership positions already in the selection of postgraduate training?

METHODS

Online survey with orthopedics/trauma surgery (OUC) and neurosurgery (NCH) residents. Comparison with gynecology (GYN). Statistical analysis, mean in percent, statistical differences using t‑ or chi²-test (significance level α = 0,05).

RESULTS

Returned questionnaire = 277, complete participation = 250. Female residents: OUC:52%, NCH:57%, GYN:85%. A total of 49% were told in medical school that a subject was inappropriate for gender reasons (f57-76%, m10-33%). The most frequent reason for a subject: all = "operating activity". The second most frequent reason: OUC-f = "good working atmosphere", OUC-m = "establishment", NCH-f = "career" and "good working atmosphere", NCH-m = "good working atmosphere", GYN-f = "establishment", GYN-m = "career". The most frequent reason against: OUC/GYN = "hardly any possibility to become established", NCH = "negative leadership style by superiors". For female residents in OUC/NCH, work/family balance had the smallest influence on the choice of specialty. Their subjective evaluation of compatibility was significantly the worst, and overall OUC/NCH was significantly worse than GYN. Although female residents in NCH were more likely to justify the specialty choice based on career goals, male residents in OUC/NCH were more likely to aim for a higher hierarchical position.

DISCUSSION

The results of this study emphasize that disciplines receive a gender-specific conditioning already at the undergraduate level, which has a clear impact on the choice of specialty. The image in this regard needs to be reconsidered, as even surgical subjects will predictably have to rely on more female specialists.

[Dream job orthopedics and trauma surgery-This can also come true for women!]

BACKGROUND

At least two thirds of medical students are female. How can they be won over in the competition for the best heads and hands in the field of orthopedics and trauma surgery? 25% of the inpatient surgeons are female, while the proportion of women in managerial positions is only 5%.

GOAL OF THE WORK (QUESTION)

How do the specialist field and the specialist society have to change in order to be attractive for the younger generation, and be regarded as a dream job?

MATERIAL AND METHODS

With the help of surveys and scientific literature, the following problem areas are identified and highlighted: What do today's young doctors want? How should employers and superiors behave in relation to the women-specific life events of pregnancy, maternity leave and breastfeeding? How to enable female surgeons to continue operating as desired in accordance with the law? Often in clinics, care is not taken to provide female surgeons with individually sized instruments. A manufacturer survey was carried out for this purpose. How can we counteract the sexual harassment and discrimination in the workplace? How can male and female professionals achieve a more equal balance between family and work in the clinic and practice?

RESULTS

The Gender Bias, the glass ceiling, the lack of female role models and female mentors mean that female surgeons do not have equal opportunities. The gender pay gap and the gender care gap are discussed and presented with data. Significantly, there is a specific lack of data on the gender pay gap in Germany. The everyday clinical practice and the professional society are still a man's world. In order to attract a sufficient number of young professionals, the working environment and participation in committees must be transformed into a world that is equal for male and female surgeons.

DISCUSSION

With regard to the identified problem areas, suggestions for improvement for active implementation are listed.