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Caturegli I, Pachano Bravo AM, Abdellah I, Fatima M, Bafford AC, Widyaningsih SA, Kaabia O. Surgeon Gender and Early Complications in Elective Surgery: A Systematic Review and Meta-analysis. Ann Surg 2025; 281:404-416. [PMID: 39045696 DOI: 10.1097/sla.0000000000006450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/25/2024]
Abstract
OBJECTIVE To examine the association between surgeon gender and early postoperative complications, including 30-day death and readmission, in elective surgery. BACKGROUND Variations between male and female surgeon practice patterns may be a source of bias and gender inequality in the surgical field, perhaps impacting the quality of care. However, there are limited and conflicting studies regarding the association between surgeon gender and postoperative outcomes. METHODS MEDLINE and Embase were searched in October 2023 for observational studies, including patients who underwent elective surgery requiring general or regional anesthesia across multiple surgical specialties. Multiple independent blinded reviewers oversaw the data selection, extraction, and quality assessment according to the PRISMA, MOOSE, and Newcastle Ottawa Scale guidelines. Data were pooled as odds ratios, using a generic inverse-variance random-effects model. RESULTS Of 944 abstracts screened, 11 studies were included in this systematic review and meta-analysis. A total of 4,440,740 postoperative patients were assessed for a composite primary outcome of mortality, readmission, and other complications within 30 days of elective surgery, with a total of 325,712 (7.3%) surgeries performed by 7072 (10.9%) female surgeons. There was no association between surgeon gender and the composite of mortality, readmission, and/or complications (odds ratio=0.97, 95% CI 0.95-1.00; I2 =64.9%; P =0.001). CONCLUSIONS These results support that surgeon gender is not associated with early postoperative outcomes, including mortality, readmission, or other complications in elective surgery. These findings encourage patients, health care providers, and stakeholders not to consider surgeon gender as a risk factor for postoperative complications.
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Affiliation(s)
- Ilaria Caturegli
- Harvard Medical School, Boston, MA
- Department of Surgery, Brigham and Women's Hospital, Boston, MA
| | | | | | | | - Andrea Chao Bafford
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | | | - Ons Kaabia
- Harvard Medical School, Boston, MA
- Faculté de Médecine de Sousse, Université de Sousse, Farhat Hached Teaching Hospital, Sousse, Tunisia
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Tracy E, Tilley L, Patzkowski J, Eliasen KM, Hudson A, Highland KB. Considerations to Optimize Structurally Responsive Work Environments for U.S. Military Specialty Physicians. Mil Med 2025; 190:e744-e750. [PMID: 39172660 DOI: 10.1093/milmed/usae395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2024] [Revised: 07/10/2024] [Accepted: 08/02/2024] [Indexed: 08/24/2024] Open
Abstract
INTRODUCTION Recruitment, training, and retention of wartime critical specialty physicians may be stymied by discrimination and abuse. It is unclear to what extent the US combat specialty physicians witness or experience discrimination and abuse, whether they or others intervene, and if they would subsequently discourage people from entering their field. MATERIALS AND METHODS The present study surveyed US active duty anesthesiologists, emergency medicine physicians, and orthopedic surgeons (N = 243; 21% response rate). A generalized linear model evaluated the extent to which gender, specialty, service, and number of witnessed/experienced negative/stigmatizing comment/event types were associated with burnout. A bootstrapped mediation analysis evaluated whether gender and burnout were mediated by the number of comment/event types. RESULTS The sample was majority non-Latine White (87%) and men (66%) with tri-service and specialty representation. The most commonly reported negative/stigmatizing comment/event types were related to pregnancy (62%) and parental leave (61%), followed by gender and assigned sex (42%), lactation (37%), and sexual harassment (35%). Of the respondents who witnessed/experienced such comments/events, self-intervention was reported after comments regarding lactation (43%), assigned sex and gender (42%), race and ethnicity (41%), pregnancy (41%), parental leave (37%), and sexual harassment (24%). Witnessing another person intervene was reported after sexual harassment (25%) and comments/events regarding race and ethnicity (24%), pregnancy (20%), assigned sex and gender (19%), lactation (19%), and parental leave (18%). Nonintervention was reported after comments/events related to parental leave (42%), pregnancy (38%), sexual harassment (26%), lactation (26%), assigned sex and gender (26%), and race and ethnicity (22%). Respondents reported moderate-to-high intervening likelihood, importance, and confidence. Respondents reporting neutral to extremely agree on prompts indicating that pregnant active duty physicians are trying to avoid deployment (P = .002) and expect special treatment that burdens the department (P = .007) were disproportionately men (36% and 38%, respectively) compared to women (14% and 18%, respectively). The highest proportion of neutral to extremely agree responses regarding discouraging specialty selection were reported in relation to transgender and gender diverse students (21%), followed by cisgender female students (18%); gay, lesbian, or bisexual+ students (17%); cisgender male students (13%); and racial and ethnic minoritized students (12%). In the primary model, the number of witnessed/experienced comment/event types was associated with greater burnout (0.13, 95% CI 0.06-0.20, P = .001), but women did not report significantly different levels of burnout than men (0.20, 95% CI -0.10 to 0.51, P = 0.20). The number of comment/event types mediated the relationship between gender and burnout (0.18, 95% CI 0.06, 0.34; P < .001). CONCLUSIONS Although reported intervening confidence, likelihood, and importance were high, it is unclear whether perceptions correspond to awareness of intervention need and behaviors. Bivariate differences in burnout levels between men and women were fully explained by the number of comment types in the mediation model. Annual trainings may not effectively address workplace climate optimization; institutions should consider targeted policy and programmatic efforts to ensure effective, structurally responsive approaches.
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Affiliation(s)
- Erin Tracy
- Department of Anesthesiology, Uniformed Services University, Bethesda, MD 20814, USA
| | - Laura Tilley
- Department of Emergency Medicine, School of Medicine and Health Sciences, George Washington University, Washington, DC 20037, USA
| | - Jeanne Patzkowski
- Department of Orthopedic Surgery, Brooke Army Medical Center, Fort Sam Houston, TX 78234, USA
- Department of Surgery, Uniformed Services University, Bethesda, MD 20814, USA
| | - Kathryn M Eliasen
- Department of Anesthesiology, Uniformed Services University, Bethesda, MD 20814, USA
- Department of Anesthesiology, Walter Reed National Military Medical Center, Bethesda, MD 20889, USA
| | - Arlene Hudson
- Department of Anesthesiology, Uniformed Services University, Bethesda, MD 20814, USA
| | - Krista B Highland
- Department of Anesthesiology, Uniformed Services University, Bethesda, MD 20814, USA
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Skan O, Tregidgo L, Tizzard J, Westlake I, Joji N. Examining medical students' experience of gender-based discrimination and sexual harassment from clinical teachers at a UK medical school. MEDICAL TEACHER 2025; 47:300-308. [PMID: 38564885 DOI: 10.1080/0142159x.2024.2331034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 03/12/2024] [Indexed: 04/04/2024]
Abstract
PURPOSE OF THE ARTICLE To quantify the prevalence and characterise the nature of gender-based discrimination (GBD) and sexual harassment (SH) arising from clinical teachers towards medical students at one UK medical school. MATERIALS AND METHODS A mixed quantitative and qualitative survey of medical students. Chi-squared analysis and logistic regression was performed on quantitative data, while an inductive thematic analysis of qualitative data was undertaken. These findings were compared to look for common patterns. RESULTS Females were significantly more likely to report experiencing both GBD (χ2 = 38.61, p < 0.0001) and SH (χ2 = 19.53, p < 0.0001) than males (OR = 10.45 (CI 4.84 - 22.56, p < 0.0001)). These behaviours were more likely to be reported in specific surgical placements than medical placements (χ2 = 15.06, p < 0.001 and χ2 = 5.90, p < 0.05). Perpetrators were more commonly male, and more commonly consultants. Exposure to GBD or SH was significantly more likely to affect the choice of specialty in females compared to males (χ2 = 11.17, p < 0.001). Students noted a casual use of sexist language, inappropriate sexual advances, and gender-based microaggressions which create a pervasive discrepancy in educational opportunities between genders. Participants reported that concerns regarding anonymity, questioning the severity of the incident, and an ingrained medical hierarchy prevented students reporting these incidents. CONCLUSIONS The rate of GBD and SH from clinical teachers to medical students remains high, affecting female students more than male students. This study highlights key areas that must be improved to achieve a more equitable teaching experience in UK medical schools. Developing robust reporting and support systems is an important step in eradicating these behaviours.
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Affiliation(s)
- Oliver Skan
- Medical Sciences Division, University of Oxford, United Kingdom
| | - Laura Tregidgo
- Medical Sciences Division, University of Oxford, United Kingdom
| | - James Tizzard
- Medical Sciences Division, University of Oxford, United Kingdom
| | - Isabel Westlake
- Medical Sciences Division, University of Oxford, United Kingdom
| | - Nikita Joji
- Royal Free London NHS Trust, London, United Kingdom
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Chen J, Pang J, An C, Li BUK, Nakae S, Zhang L. Exploring the intersectionality of race and gender on the incidence of and response to microaggression experienced by Asian American women medical students. Am J Surg 2025; 239:116007. [PMID: 39427461 DOI: 10.1016/j.amjsurg.2024.116007] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2024] [Revised: 09/23/2024] [Accepted: 10/04/2024] [Indexed: 10/22/2024]
Abstract
BACKGROUND Discrimination faced by Asian American trainees in medical school include those reported by female trainees. This study aims to characterize the microaggressions faced by Asian American woman medical students. METHODS We use a mixed methods approach to characterize the experiences of Asian Americans in United States (US) medical schools through an anonymous online survey and participation in focus groups. RESULTS Among our 305 participants, 65.9 % were women. More women experienced microaggressions than men (p < 0.001). Compared to men, women reported significantly higher rates of supervisors having higher expectations of them, implying they were submissive, and describing them as too quiet. Women felt that their experiences with microaggressions were entangled with being Asian and a woman, but could not distinguish which identity was being targeted. CONCLUSION The intersectionality of being Asian American and a woman in medical training has not been explored. We found that this duality intensified experiences of microaggressions.
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Affiliation(s)
- Joanna Chen
- University of Toledo College of Medicine and Life Sciences, 2801 W. Bancroft, Toledo, OH, 43606, USA.
| | - Joyce Pang
- Department of Surgery, Oregon Health & Science University, 3181 S.W. Sam Jackson Park Rd., Portland, OR, 97239, USA.
| | - Crystal An
- Case Western Reserve University School of Medicine, 9501 Euclid Ave, Cleveland, OH, 44106, USA.
| | - B U K Li
- Department of Pediatrics, Medical College of Wisconsin, 9000 W. Wisconsin Ave, Milwaukee, WI, 53226, USA.
| | - Sunny Nakae
- Department of Medical Education, California University of Science and Medicine School of Medicine, 1501 Violet Street, Colton, CA, 92324, USA.
| | - Lindy Zhang
- Sidney Kimmel Comprehensive Cancer Center and Department of Oncology, Johns Hopkins University School of Medicine, 1800 Orleans Street, Baltimore, MD, 21287, USA.
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Archuleta S, Ibrahim H, Pereira TLB, Shorey S. Microaggression Interactions Among Healthcare Professionals, Trainees and Students in the Clinical Environment: A Mixed-Studies Review. TRAUMA, VIOLENCE & ABUSE 2024; 25:3843-3871. [PMID: 39082181 DOI: 10.1177/15248380241265380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2024]
Abstract
This review aims to comprehensively consolidate and synthesize the existing body of empirical research on the perceptions and experiences of healthcare professionals, trainees, and students concerning microaggression interactions within diverse clinical settings. The review protocol was registered with the international prospective register of systematic reviews (PROSPERO CRD42024546443). We employed the Joanna Briggs Institute's mixed-methods systematic review approach. Comprehensive electronic database searches were conducted across eight databases (Medline, Embase, CINAHL, PsycINFO, Scopus, Web of Science, Social Science Database, and ProQuest Dissertation and Theses) from their respective inception dates up to October 1, 2023. The selection criteria included studies reporting instances of interprofessional or intra-professional microaggressions occurring in clinical environments among healthcare professionals, trainees, and students identifying as heterosexual and without disabilities. In total, 37 studies met the eligibility criteria and were included in our review. Our analysis revealed three primary themes: Racial Microaggressions in the Clinical Environment, Gender Microaggressions in the Clinical Environment, and Religious Microaggressions in the Clinical Environment. Research must delve deeply into these experiences to better understand their long-term consequences, while policy initiatives should be designed to establish equitable, inclusive, and respectful healthcare environments. Collaborative endeavors bridging research and policy are paramount to dismantling barriers and nurturing an inclusive healthcare landscape.
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Affiliation(s)
- Sophia Archuleta
- National University of Singapore, Singapore
- National University Hospital, National University Health System, Singapore, Singapore
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Lund S, Griffeth EM, Williamson A, Collings A, Gudmundsdottir H, Han A, Kearse L, Kratzke IM, Wilkins P, Prokop LJ, Cook DA. Gender Differences in Autonomy Granted to Residents and Fellows During Procedural Training: A Systematic Review and Meta-Analysis. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2024; 99:922-930. [PMID: 38412483 DOI: 10.1097/acm.0000000000005673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/29/2024]
Abstract
PURPOSE Supervisors may be prone to implicit (unintentional) bias when granting procedural autonomy to trainees due to the subjectivity of autonomy decisions. The authors aimed to conduct a systematic review and meta-analysis to assess the differences in perceptions of procedural autonomy granted to physician trainees based on gender and/or race. METHOD MEDLINE, Embase, CENTRAL, Scopus, and Web of Science were searched (search date: January 5, 2022) for studies reporting quantitative gender- or race-based differences in perceptions of procedural autonomy of physician trainees. Reviewers worked in duplicate for article selection and data abstraction. Primary measures of interest were self-reported and observer-rated procedural autonomy. Meta-analysis pooled differences in perceptions of procedural autonomy based on trainee gender. RESULTS The search returned 2,714 articles, of which 16 were eligible for inclusion. These reported data for 6,109 trainees (median, 90 per study) and 2,763 supervisors (median, 54 per study). No studies investigated differences in perceptions of autonomy based on race. In meta-analysis of disparities between genders in autonomy ratings (positive number favoring female trainees), pooled standardized mean differences were -0.12 (95% confidence interval [CI], -0.19 to -0.04; P = .003; n = 10 studies) for trainee self-rated autonomy and -0.05 (95% CI, -0.11 to 0.01; P = .07; n = 9 studies) for supervisor ratings of autonomy. CONCLUSIONS Limited evidence suggests that female trainees perceived that they received less procedural autonomy than did males. Further research exploring the degree of gender- and race-based differences in procedural autonomy, and factors that influence these differences is warranted.
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Daneshgaran G, Thrikutam N, Dasari M, Bisgaard E. A Pilot Needs Assessment Addressing Gender-Based Microaggressions in Surgical Trainees. JOURNAL OF SURGICAL EDUCATION 2024; 81:918-928. [PMID: 38749819 DOI: 10.1016/j.jsurg.2024.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Revised: 04/09/2024] [Accepted: 04/15/2024] [Indexed: 06/11/2024]
Abstract
BACKGROUND Microaggressions result in the unintentional discrimination of marginalized groups. Female trainees are underrepresented in all levels of surgical training, thus, microaggressions are a salient topic for surgical education. This study aims to explore the perceived effect of gender-based microaggressions on surgical trainees. METHODS After IRB approval, an anonymous Likert-scaled survey on perceptions of microaggressions was distributed to interns at our institution prior to starting surgical residency and one year after. Data was de-identified and analyzed using Likert analysis and Mann-Whitney U testing. Follow-up focus groups were lead and transcriptions analyzed using detailed thematic analysis. RESULTS Sixty-nine of 104 interns (66%) responded to the initial survey, 34 (49%) were female. Nineteen of 38 interns (50%) responded to the follow-up survey, 10 (53%) were female. Compared to male repondents, females were significantly more likely to believe they were likely to experience microaggressions (median = 5, IQR 4-5 vs median = 4, IQR 3-4, p < 0.0001) and that microaggressions would impact their mental health (median = 4, IQR 4-4 vs median = 3, IQR 2-4, p < 0.0002). One-year follow-up data similarly revealed that, compared to male respondents, females were significantly more likely to have experienced microaggressions on a frequent basis throughout intern year (median = 3, IQR 3-3.75 vs median = 1.5, IQR 1-3, p < 0.05) and to have subjectively felt the impact of microaggressions on their mental health (median = 3, IQR 2.25-4 vs median = 1.5, IQR 1-2.25, p < 0.05). A focus group of female surgical trainees demonstrated patterns consistent with previously validated themes on gender-based microaggressions, including environmental invalidations, being treated as a second class citizen, and assumption of inferiority, at all levels of training. CONCLUSIONS New trainees experience anxiety and lack preparedness when confronted with the threat of microaggressions. Our study reveals that female surgical interns are more likely than males to worry about microaggressions and to experience microaggressions and their negative effects. Focus group data exposes the wide-ranging impact of microaggressions experienced by female trainees of all levels. Thus, there should be benefit from instituting formal microaggression training prior to starting surgical residency.
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Affiliation(s)
- Giulia Daneshgaran
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Washington, Harborview Medical Center, Seattle, WA 98104
| | - Nikhitha Thrikutam
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Washington, Harborview Medical Center, Seattle, WA 98104
| | | | - Erika Bisgaard
- Division of Trauma, Burn, and Critical Care Surgery, Department of Surgery, University of Washington, Harborview Medical Center, Seattle, WA 98104.
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Ogunnowo S, Zakrison TL, Baird B, Erben Y, Tung EL, Yang JP, Dorsey C. Exploring Experiences of Traumatic Microaggressions Toward Surgeons and Surgical Residents. J Surg Res 2024; 295:191-202. [PMID: 38035870 PMCID: PMC10922079 DOI: 10.1016/j.jss.2023.10.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 09/09/2023] [Accepted: 10/27/2023] [Indexed: 12/02/2023]
Abstract
INTRODUCTION Studies have suggested that experiences of gender and racial discrimination are widespread among surgeons and surgical residents. This study examines the relationship between experienced microaggressions and traumatic stress. METHODS A one-time, deidentified survey was distributed over email to academic surgical societies. The survey consisted of 35 items including questions on prevalence of microaggressions, perceived job impacts as well as a shortened version of the Trauma Symptoms of Discrimination Scale. Chi-square tests and an independence test for trends were utilized to determine significance. RESULTS We collected data from 130 participants with majority (81%) having experienced microaggressions in the workplace. On measures of worry (P < 0.001), avoidance (P = 0.012), anxiety (P = 0.004), and trouble relaxing (P = 0.002), racial/ethnic minority surgeons and trainees demonstrated significantly higher scores. With perceived job impacts, significant agreement was seen with occurrences of working harder to prove competence (P = 0.005), gaining patient confidence (P < 0.001), reduced career satisfaction (P = 0.011), work-related negative talk (P = 0.018), and burnout at work due to microaggressions (P = 0.019). Among participants who underwent behavioral modifications, female surgeons were more likely to change their nonverbal communication styles (P < 0.001) and spend more time with patients (P < 0.001). CONCLUSIONS Experiences of microaggressions are associated with increased anxiety-related trauma symptoms in racial/ethnic minority surgeons and surgical trainees. Additionally, these experiences of microaggression can influence job satisfaction, burnout, career perceptions and workplace behaviors. As the field of surgery becomes more diverse, this study contributes to growing awareness of the role of implicit discrimination in the attrition and retention of racial/ethnic minority surgeons and female surgeons.
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Affiliation(s)
- Simi Ogunnowo
- Pritzker School of Medicine, University of Chicago, Chicago, Illinois.
| | - Tanya L Zakrison
- Department of Surgery, University of Chicago Medicine, Chicago, Illinois
| | - Brandon Baird
- Department of Surgery, University of Chicago Medicine, Chicago, Illinois
| | - Young Erben
- Department of Surgery, Mayo Clinic, Jacksonville, Florida
| | - Elizabeth L Tung
- Department of Medicine, University of Chicago Medicine, Chicago, Illinois
| | - Joyce P Yang
- Department of Psychology, The University of San Francisco, San Francisco, California
| | - Chelsea Dorsey
- Department of Surgery, University of Chicago Medicine, Chicago, Illinois
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Vervoort D, Elfaki LA, Servito M, Herrera-Morales KY, Kanyepi K. Redefining global cardiac surgery through an intersectionality lens. MEDICAL HUMANITIES 2024; 50:109-115. [PMID: 38388185 DOI: 10.1136/medhum-2023-012801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/21/2023] [Indexed: 02/24/2024]
Abstract
Although cardiovascular diseases are the leading cause of morbidity and mortality worldwide, six billion people lack access to safe, timely and affordable cardiac surgical care when needed. The burden of cardiovascular disease and disparities in access to care vary widely based on sociodemographic characteristics, including but not limited to geography, sex, gender, race, ethnicity, indigeneity, socioeconomic status and age. To date, the majority of cardiovascular, global health and global surgical research has lacked intersectionality lenses and methodologies to better understand access to care at the intersection of multiple identities and traditions. As such, global (cardiac) surgical definitions and health system interventions have been rooted in reductionism, focusing, at most, on singular sociodemographic characteristics. In this article, we evaluate barriers in global access to cardiac surgery based on existing intersectionality themes and literature. We further examine intersectionality methodologies to study access to cardiovascular care and cardiac surgery and seek to redefine the definition of 'global cardiac surgery' through an intersectionality lens.
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Affiliation(s)
- Dominique Vervoort
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Lina A Elfaki
- University of Toronto Temerty Faculty of Medicine, Toronto, Ontario, Canada
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Sims HS, Kan K, Lechien JR. Microaggressions in European versus American Workplace Environments of Otolaryngology-Head and Neck Surgery. Laryngoscope Investig Otolaryngol 2023; 8:1589-1601. [PMID: 38130270 PMCID: PMC10731495 DOI: 10.1002/lio2.1178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 10/20/2023] [Accepted: 10/24/2023] [Indexed: 12/23/2023] Open
Abstract
Objective To compare the workplace experience of European and U.S. members of the otolaryngology community. Methods European and U.S. otolaryngologists-head and neck surgeons (OTO-HNS) were surveyed through three otorhinolaryngological societies. We inquired about personal and observed experiences of differential treatment in the workplace related to age, biological sex, ethnicity, disability, gender identity, political belief, and sexual orientation. Results were compared according to the world region. Differential treatment was used as a proxy for microaggressions. Results A total of 348 practitioners participated in the survey: 148 American and 230 European OTO-HNS. European OTO-HNS reported significantly higher proportions of observed or personal experiences of differential treatment based on age (p = .049), language proficiency (p = .027), citizenship (p = .001), hair texture (p = .017), height/weight (p = .002), clothing (p = .011), and professionalism (p = .002) compared with U.S. OTO-HNS. Differential treatment related to political belief (p = .043), socioeconomic status (p = .018), and ethnicity (p = .001) were higher in the United States compared with Europe. Feelings of exclusion (p = .027) and consideration of leaving their position (p = .001) were significantly higher in the United States compared with Europe. In both the United States and Europe, female OTO-HNS reported more frequent differential treatment related to biological sex than males. Conclusion Differential treatment, or microaggressions, related to personal characteristics or behavior varied in the United States and Europe with more ethnicity-based microaggressions in the United States and physical characteristic-based microaggressions in Europe. In both regions, females were more subject to microaggressions than males. More efforts are needed to tackle microaggressions and discrimination in the clinical and academic workplace of the Western otolaryngology community. Level of Evidence 4.
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Affiliation(s)
- H. Steven Sims
- Department of Otolaryngology‐Head & Neck SurgeryChicago Institute for Voice Care, University of Illinois at ChicagoChicagoIllinoisUSA
- Department of Otolaryngology‐Head & Neck SurgeryUniversity of Illinois at ChicagoChicagoIllinoisUSA
| | - Krystal Kan
- Department of Otolaryngology‐Head & Neck SurgeryUniversity of Illinois at ChicagoChicagoIllinoisUSA
| | - Jerome R. Lechien
- Division of Laryngology and Broncho‐esophagology, Department of Otolaryngology and Head and Neck SurgeryEpiCURA Hospital, UMONS Research Institute for Health Sciences and Technology, University of MonsMonsBelgium
- Department of Otolaryngology‐Head & Neck SurgeryCHU Saint‐PierreBrusselsBelgium
- Elsan Polyclinic of PoitiersPoitiersFrance
- Research Committee of Young Otolaryngologists of the International Federation of Otorhinolaryngological Societies (YO‐IFOS)ParisFrance
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Lee YS, Campany M, Fullerton S, Malik R, Dorsey C, Mercado D, Allen A, Erben Y. State of Gender-Based Microaggressions Among Surgeons and Development of Simulation Workshops for Addressing Microaggressions for Surgical Trainees and Students. Ann Vasc Surg 2023; 95:285-290. [PMID: 36963719 DOI: 10.1016/j.avsg.2023.03.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Revised: 03/02/2023] [Accepted: 03/04/2023] [Indexed: 03/26/2023]
Abstract
BACKGROUND Microaggressions are statements or actions taken in a discriminatory manner. Microaggressions can be subtle or explicit, intentional or unintentional, but regardless of the type of microaggressions, it is important to identify and address them, as they are linked to physician burnout and add to levels of depression, anxiety, and stress. In this study, we evaluated the prevalence, quality, and impacts of gender-based microaggressions on surgeons and surgical trainees using simulation-based education. Further, we plan to iteratively develop more simulation sessions based on the findings of this study. METHODS We used simulation-based education to develop and implement microaggression scenarios. Those scenarios were performed by standardized patients (trained actors) who demonstrated the different microaggression situations previously seen at the workplace and wards. Published tools to address gender-based microaggressions were outlined in preparation (prebrief) for a discussion of recorded simulations. A debrief of developing potential resolutions as learners and future allies and how similar microaggressions may have been perpetuated in our own careers followed each scenario. Additionally, an 11-item survey was developed based on validated surveys of sexist and Microaggressions Experience and Stress Scale and disseminated through email listservs and social media links. Data collection occurred from November to December 2022. RESULTS When surveyed after the workshop, 100% of participants (n = 6) said that they would recommend this session to follow colleagues, and 100% completely agreed the content of the simulation was relevant to their future practice. Further, 100% of participants agreed or completely agreed that their ability to perform these tasks (addressing microaggressions) has improved after this course. Most respondents to the disseminated survey (n = 147) were vascular surgeons (95/147; 64.6%) and identified as White (93/147; 63.3%), and as women (142/147; 96.6%). Most were identified as targets of gender-based microaggressions (128/147; 87.1%) and or silent witnesses to such microaggressions (87/147; 59.2%). However, there were reports of having a perpetrator of a microaggression (2/147; 1.4%), a nonsilent witness (3/147; 2.0%), or having no target, witness, or perpetrator (3/147; 2.0%). Of the quality of microaggressions, the most common impacts were when the targeted individual attempted to hide their emotions to not appear too emotional (described in the literature as "leaving gender at the door") (32/147; 21.8%), were told that women no longer experience discrimination (25/147; 17.0%), and were asked when one would have children (24/147; 16.3%). The most stressful types of microaggressions were ones in which male peers were the only ones receiving recognition for work (55/147; 37.4%), targets were told women no longer experience discrimination (49/147; 33.3%), and in which men spoke about women in degrading terms regarding their gender or on topics related to their gender (35/147; 23.8%). Qualitative responses to the survey included comments remarking on the relevancy and prevalence of gender-based microaggressions, reasons for silence, the personal and professional impacts (e.g., pay equity) of microaggressions and gender bias, and future areas of work to address bias in medicine. CONCLUSIONS Given the prevalence of microaggressions seen in surgery, especially among vascular surgeons, future steps include discussion of how techniques can be developed and applied to other types of microaggressions (e.g., due to race/ethnicity, sexuality, disability, religion), implementation of future workshops that address intersectionality in scenarios and potentially virtual sessions to increase accessibility to these types of training options for learners at other institutions.
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Affiliation(s)
- Yeonsoo S Lee
- Mayo Clinic Alix School of Medicine, Mayo Clinic Florida, Jacksonville, FL
| | - Megan Campany
- Mayo Clinic Alix School of Medicine, Mayo Clinic Arizona, Scottsdale, AZ
| | - Shalyn Fullerton
- Mayo Clinic Alix School of Medicine, Mayo Clinic Florida, Jacksonville, FL
| | - Rafay Malik
- Mayo Clinic Alix School of Medicine, Mayo Clinic Florida, Jacksonville, FL
| | - Chelsea Dorsey
- Section of Vascular Surgery and Endovascular Therapy, The University of Chicago Medicine and Biological Sciences, Chicago, IL
| | - Deisy Mercado
- Simulation Center, Mayo Clinic Florida, Jacksonville, FL
| | - Amy Allen
- Simulation Center, Mayo Clinic Florida, Jacksonville, FL
| | - Young Erben
- Division of Vascular and Endovascular Surgery, Mayo Clinic Florida, Jacksonville, FL.
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Carino Mason MR, Pandya S, Joshi P, Cai N, Murdock CJ, Hui-Chou HG. Perceptions of Racial and Gender Microaggressions in an Academic Orthopaedic Department. JB JS Open Access 2023; 8:e22.00150. [PMID: 37554580 PMCID: PMC10405998 DOI: 10.2106/jbjs.oa.22.00150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/10/2023] Open
Abstract
UNLABELLED Orthopaedic surgery consistently ranks last among all medical specialties in diversity and inclusion. While active efforts have recently been implemented to enact change, no study to date has explored the potential effects that social microaggressions have on an individual's career in orthopaedic surgery. The primary aim of this study was to investigate the influence of the perceived experiences of gender and race-based microaggressions on orthopaedic surgery residents, fellows, and attendings in their decision to pursue a career in orthopaedic surgery. METHODS A 34-question institutional review board-approved, modified version of the validated Racial and Ethnic Minorities Scale and Daily Life Experiences survey was sent to a total of 84 individuals at the University of Miami (UM) Department of Orthopaedics. Responses were anonymously collected from current UM orthopaedic residents, fellows, and attendings. Survey results were analyzed for the prevalence of microaggressions in the context of sex, race, ethnicity, academic goals, daily scenarios, and department support. p-Values less than 0.05 were considered statistically significant. RESULTS Fifty-four of 84 respondents (64%) completed the survey. Female respondents experienced significantly more gender-based microaggressions than male respondents. On average, male participants disagreed that their experiences with microaggressions made them doubt their ability to pursue a career in orthopaedic surgery while female participants responded they were neutral. In comparison with their White counterparts, non-White and Hispanic ethnicity participants demonstrated a statistically significantly greater frequency of race and ethnicity-based microaggressions. CONCLUSION Our study demonstrates that female participants, non-White participants, and Hispanic minorities across all levels of training experience a higher frequency of microaggressions. The impact of these experiences on career decisions and goals for women and persons of color in orthopaedic surgery at this single institution is mixed. Experienced microaggressions should be further investigated as a potential barrier to recruitment and retention of under-represented minorities in orthopaedic surgery. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Marisa R. Carino Mason
- Department of Orthopaedic Surgery, University of Miami Miller School of Medicine, Miami, Florida
| | - Shivani Pandya
- Department of Orthopaedic Surgery, University of Miami Miller School of Medicine, Miami, Florida
| | - Priyashma Joshi
- Department of Orthopaedic Surgery, University of Miami Miller School of Medicine, Miami, Florida
| | - Nathan Cai
- Department of Orthopaedic Surgery, University of Miami Miller School of Medicine, Miami, Florida
| | - Christopher J. Murdock
- Department of Orthopaedic Surgery, University of Miami Miller School of Medicine, Miami, Florida
| | - Helen G. Hui-Chou
- Department of Orthopaedic Surgery, University of Miami Miller School of Medicine, Miami, Florida
- Division of Hand, Peripheral Nerve & Upper Extremity Reconstructive Surgery, Department of Orthopaedic Surgery, University of Miami, Miami, Florida
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Thiart M, O’Connor M, Müller J, Holland N, Bantjes J. Operating in the margins: Women's lived experience of training and working in orthopaedic surgery in South Africa. QUALITATIVE RESEARCH IN MEDICINE & HEALTHCARE 2023; 7:10902. [PMID: 37441128 PMCID: PMC10336873 DOI: 10.4081/qrmh.2023.10902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 03/08/2023] [Indexed: 07/15/2023] Open
Abstract
Medicine in South Africa (SA), as in other parts of the world, is becoming an increasingly gender diverse profession, yet orthopaedic surgery continues to be dominated by men, with women constituting approximately 5% of the profession in SA. The aim of this descriptive qualitative study was to explore women's experiences of training and working as orthopaedic surgeons in SA and identify structures, practices, attitudes, and ideologies that may promote or impede the inclusion of women. Data were collected via focus group discussions with women orthopaedic surgeons (n=16). Grounded in phenomenology, data were analysed using thematic analysis following a data-driven inductive approach to making sense of participants' experiences. Five main themes emerged: i) dynamic working environments and the work of transformation; ii) negotiating competing roles of mother and surgeon; iii) belonging, exclusion and internalised sexism; iv) gaslighting and silencing; and v) acts of resistance - agency and pushing back. The findings highlight the dynamic process in which both men and women contribute to co-creating, re-producing, and challenging practices that make medicine more inclusive.
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Affiliation(s)
- Mari Thiart
- Division of Orthopaedic Surgery, Department of Surgical Sciences, Faculty of Medicine and Health Sciences, Tygerberg, Stellenbosch University
| | - Megan O’Connor
- Department of Orthopaedic Surgery, Inkosi Albert Luthuli Central Hospital, School of Clinical Medicine, University of KwaZulu-Natal
| | - Jana Müller
- Ukwanda Centre for Rural Health, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University
| | - Nuhaa Holland
- Institute for Life Course Health Research, Department of Global Health, Stellenbosch University
| | - Jason Bantjes
- Institute for Life Course Health Research, Department of Global Health, Stellenbosch University
- Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, Cape Town, South Africa
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Miller SM, Maul TM, Wei JL. Physician experiences of workplace racial and gender microaggressions. Int J Pediatr Otorhinolaryngol 2023; 168:111516. [PMID: 37003015 DOI: 10.1016/j.ijporl.2023.111516] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Revised: 03/04/2023] [Accepted: 03/19/2023] [Indexed: 04/03/2023]
Abstract
OBJECTIVES To investigate racial and gender-specific microaggressions that are experienced by pediatric otolaryngologists at work. METHODS An anonymous web-based survey consisting of 18 questions was sent to American Society of Pediatric Otolaryngology (ASPO) members via an email link. The survey included questions from the Workplace and School Microaggressions component of the Racial and Ethnic Microaggressions (REM) Scale. RESULTS 125 out of 610 ASPO members completed the survey for a response rate of 20.5%. 28% of respondents reported experiencing a racial/ethnic microaggression in the last six months. Respondents who identified as Asian American Pacific Islander had significantly higher REM scores when compared with Caucasian respondents (p < 0.05). There was no significant difference in scores when comparing the other Race categories. Female respondents reported significantly higher gendered-microaggression scores compared to those identifying as male (p < 0.001). 66% of female respondents experienced some form of gender-based microaggression in the last six months. CONCLUSION By providing evidence that pediatric otolaryngologists continue to report experiences of discrimination in the form of microaggressions, this study aims to increase awareness and inspire a more inclusive work environment.
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Affiliation(s)
- Stefanie M Miller
- University of Central Florida College of Medicine, Orlando, FL, USA.
| | - Timothy M Maul
- University of Central Florida College of Medicine, Orlando, FL, USA; Department of Cardiovascular Services, Nemours Children's Health, Orlando, FL, USA; Department of Bioengineering, University of Pittsburgh, Pennsylvania, USA
| | - Julie L Wei
- University of Central Florida College of Medicine, Orlando, FL, USA
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Koutsouras GW, Zhang L, Zanon N, Lam S, Boop FA, Tovar-Spinoza Z. Equity in neurosurgery: a worldwide survey of women neurosurgeons. J Neurosurg 2023; 138:550-558. [PMID: 35907187 DOI: 10.3171/2022.6.jns22466] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 06/02/2022] [Indexed: 02/04/2023]
Abstract
OBJECTIVE The global neurosurgery workforce does not have a defined stance on gender equity. The authors sought to study and characterize the demographic features of the international women neurosurgery community and to better understand the perceptions and reflections of their neurosurgical careers. The objective was to define and characterize the workplace inequities faced by the global women neurosurgeon community. METHODS A 58-item cross-sectional survey was distributed to the global women neurosurgery community. The survey was distributed via an online and mobile platform between October 2018 and December 2020. Responses were anonymized. The authors utilized chi-square analysis to differentiate variables (e.g., career satisfaction) between various groups (e.g., those based on academic position). The authors calculated 95% CIs to establish significance. RESULTS Among 237 respondents, approximately 40% were between the ages of 26 and 35 years. Within their respective departments, 45% identified themselves as the only woman neurosurgeon in their practice. Forty-three percent stated that their department supported women neurosurgeons for leadership roles. Seventy-five percent of respondents were members of organized neurosurgery professional societies; of these, 38% had been involved in leadership roles. Almost 60% of respondents postponed their decision to get pregnant because of resident or work-related influences. CONCLUSIONS This survey provides international feedback for characterizing and understanding the experiences of women neurosurgeons worldwide. Future research should aim to understand all neurosurgeons' experiences throughout the pipeline and career life cycle of neurosurgery in order to improve the field of neurosurgery.
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Affiliation(s)
- George W Koutsouras
- 1Department of Neurosurgery, SUNY Upstate Medical University, Syracuse, New York
| | - Lu Zhang
- 2Division of Pediatric Neurosurgery, Ann & Robert Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Nelci Zanon
- 3Department of Neurosurgery, Federal University of São Paulo, Brazil; and
| | - Sandi Lam
- 2Division of Pediatric Neurosurgery, Ann & Robert Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Frederick A Boop
- 4Department of Neurological Surgery, University of Tennessee Health Sciences Center, LeBonheur Children's Hospital Neurosciences Institute, Semmes-Murphey Clinic, Memphis, Tennessee
| | - Zulma Tovar-Spinoza
- 1Department of Neurosurgery, SUNY Upstate Medical University, Syracuse, New York
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Georgi M, Morka N, Patel S, Kazzazi D, Karavadra K, Nathan A, Hardman G, Tsui J. The Impact of Same Gender Speed-Mentoring on Women's Perceptions of a Career in Surgery - A Prospective Cohort Study. JOURNAL OF SURGICAL EDUCATION 2022; 79:1166-1176. [PMID: 35691892 DOI: 10.1016/j.jsurg.2022.05.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 05/12/2022] [Accepted: 05/16/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Mentoring is critically important for the personal and professional development of a surgeon. Early career stage mentoring by same-gender role models may help ameliorate the gender imbalance in surgery based on our understanding of barriers for women pursuing surgical careers. A novel method of establishing these relationships is speed mentoring. This study aims to examine the impact of a one-day speed-mentoring session with same gender mentors on a cohort's perceptions of a career in surgery. DESIGN This prospective pre-post study compared attitudes and perceptions of a career in surgery before and after a speed-mentoring session with female surgeons. Mentees were assigned into groups of 1 or 2 and were paired with a female surgeon for 8 minutes. Each mentee group then rotated to another mentor for the same amount of time and this process continued for a total of twelve sessions. Mentees completed a 19-point questionnaire before and after the speed mentoring intervention. SETTING This multicenter study included participants from across the United Kingdom. PARTICIPANTS Inclusion criteria were female gender and medical student or foundation year doctor (internship year 1 or 2) status. Three hundred and forty participants participated in the intervention, 191 were included in the analysis. RESULTS Following intervention, the percentage of participants who agreed that having a family would negatively impact a woman's surgical career progression significantly decreased from 46.6% to 23.0%. The percentage of participants who agreed that an "old boys' club" attitude exists in surgery also significantly decreased (73.8%-58.1%). The percentage of participants who agreed it was more difficult for a woman to succeed in her surgical career than a man significantly decreased (73.8%-64.9%). One hundred and eighty-three (96%) participants agreed that mentorship is important for career progression and 153 (71.2%) participants stated that they did not have someone who they considered a mentor. CONCLUSIONS Conducting a speed mentoring program with same-gender role models significantly changed female medical students' and junior doctors' perceptions of women in surgery. The results suggest that such programs may be effective tools for facilitating mentor-mentee relationships and could be employed by surgical organizations to encourage a diverse uptake into surgery.
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Affiliation(s)
- Maria Georgi
- School of Medicine, University College London, London, United Kingdom.
| | - Naomi Morka
- School of Medicine, University College London, London, United Kingdom
| | - Sonam Patel
- School of Medicine, University College London, London, United Kingdom
| | - Danny Kazzazi
- School of Medicine, University College London, London, United Kingdom
| | - Khimi Karavadra
- School of Medicine, University College London, London, United Kingdom
| | - Arjun Nathan
- Division of Surgery and Interventional Science, University College London, London, United Kingdom
| | - Gillian Hardman
- Cardiothoracic Surgery NTN, Health Education England, Manchester, United Kingdom
| | - Janice Tsui
- Division of Surgery and Interventional Science, University College London, London, United Kingdom
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Pahwa B, Kalyani M, Jain I, Bhattacharjee S. Will you choose neurosurgery as your career? An Indian female medical student perspective. J Clin Neurosci 2022; 105:1-8. [PMID: 36049362 DOI: 10.1016/j.jocn.2022.08.015] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 08/11/2022] [Accepted: 08/21/2022] [Indexed: 11/16/2022]
Abstract
OBJECTIVE We aim at recognising the reasons that discourage female medical students to consider neurosurgery as a career, from an Indian perspective. METHODOLOGY An online survey was disseminated in various medical colleges of India. The study included female medical students (both cis and trans). The questionnaire consisted of objective questions on mentorship, opportunities and exposure. Their concerns on long working hours and the reasons for the same were recorded. RESULTS 348 responses were included of which 79.9 % of students felt they didn't receive proper exposure to neurosurgery in their medical school. 87.4 % of the respondents faced a lack of opportunity and mentorship for research. 65.2 % of students felt that they would be more interested in neurosurgery if a female professor were to mentor them. Long working hours and Reduced Family and Personal time were identified as statistically significant factors (p < 0.001) that play a role in demotivating female medical students towards neurosurgery. Altered quality of life was the most frequent (79.49 %) and significant reason (p = 0.004) as to why long working hours were a concern for them. 65.07 % of participants did not consider physical strength to be a hurdle (p = 0.008). Approximately 37.6 % participants felt that maternity and neurosurgery could be incompatible (p = 0.005). CONCLUSIONS The study brings out the notions that female medical students have regarding the long working hours and decreased family and personal time, complicated by pregnancy and maternal leave in the life of female neurosurgeon.
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Affiliation(s)
- Bhavya Pahwa
- University College of Medical Sciences and GTB Hospital, New Delhi, India.
| | | | - Ishika Jain
- North DMC Medical College & Hindu Rao Hospital, New Delhi, India
| | - Suchanda Bhattacharjee
- Additional. Professor Department of Neurosurgery, Nizam's Institute Of Medical Sciences, Hyderabad, India
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Galhotra S, Smith RB, Norton T, Mahnert ND. The surgical gender gap: the impact of surgeon gender in medicine and gynecologic surgery. Curr Opin Obstet Gynecol 2022; 34:256-261. [PMID: 35895969 DOI: 10.1097/gco.0000000000000788] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW The purpose of this review is to summarize the current literature evaluating the effect of surgeon gender on patient outcomes and satisfaction, and the impact of gender bias on female surgeons. RECENT FINDINGS The proportion of female physicians has increased in recent years, especially in Obstetrics and Gynecology. Recent literature assessing this impact supports equivalent or superior medical and surgical outcomes for women surgeons and physicians. It also reveals superior counseling and communication styles as perceived by patients. However, women in medicine receive lower patient ratings in competence, medical knowledge, and technical skills despite the existing evidence. Additionally, female physicians experience pay inequality, limited advancement opportunities, higher prevalence of microaggressions, and higher rates of burnout. SUMMARY Recognition of gender bias is essential to correcting this issue and improving the negative impact it has on female physicians, our patients, and the field of women's health.
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Affiliation(s)
- Sheena Galhotra
- Banner University Medical Center Phoenix, University of Arizona College of Medicine Phoenix, Phoenix, Arizona, USA
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Sharma D, Yadav SK, Agarwal P. A Clarion Call for More Qualitative Studies in Surgery. Indian J Surg 2022. [DOI: 10.1007/s12262-021-03022-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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20
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Lombarts KMJ, Verghese A. Medicine Is Not Gender-Neutral - She Is Male. N Engl J Med 2022; 386:1284-1287. [PMID: 35353969 DOI: 10.1056/nejmms2116556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Kiki M J Lombarts
- From the Department of Medical Psychology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam (K.M.J.L.); and the Center for Advanced Study in the Behavioral Sciences (K.M.J.L.), the Presence Center, Department of Medicine (K.M.J.L., A.V.), and the Department of Internal Medicine (A.V.), Stanford University School of Medicine, Stanford, CA
| | - Abraham Verghese
- From the Department of Medical Psychology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam (K.M.J.L.); and the Center for Advanced Study in the Behavioral Sciences (K.M.J.L.), the Presence Center, Department of Medicine (K.M.J.L., A.V.), and the Department of Internal Medicine (A.V.), Stanford University School of Medicine, Stanford, CA
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Green RL, Kling SM, Dunham P, Erkmen CP, Kuo LE. Gender Diversity in Surgery: A Review. CURRENT SURGERY REPORTS 2022. [DOI: 10.1007/s40137-022-00314-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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22
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Sharma M, Rawal S. Women in Medicine: The Limits of Individualism in Academic Medicine. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2022; 97:346-350. [PMID: 34647925 DOI: 10.1097/acm.0000000000004458] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
In the 21st century, more than ever before, issues facing women in medicine, such as pay equity and workplace harassment, are being explored and attended to by physicians and health care institutions. Discussions about women in medicine almost exclusively center around women physicians, even though most women in medicine are, in fact, not physicians. In addition, these discussions typically focus on gender, often failing to consider how race, class, and other dimensions of identity influence the experiences of women in medicine. In this article, the authors argue that neoliberal feminism is the dominant strand of feminism in the discourse of women in medicine. With its focus on the individual and a conception of success defined in largely economic terms, neoliberal feminism fails to consider the broader conditions in which women are situated and, therefore, limits structural criticism and the possibility for all women to engage in social justice. The authors suggest that the pandemic is an opportunity to pursue a more expansive vision of feminism in medicine. They propose intersectional feminism as a theoretical framework that can widen the understanding of what is possible: moving from individual actions resulting in incremental change to collective action that can transform systems. Intersectional feminism enables a push for structures, institutions, and practices that support all workers, including basic income, labor protections, public childcare, accessible health care, transportation justice, and migrant rights. In so doing, intersectional feminism calls for solidarity with and among women both within and outside of medicine.
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Affiliation(s)
- Malika Sharma
- M. Sharma is an infectious disease physician, St. Michael's Hospital, and assistant professor, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Shail Rawal
- S. Rawal is a general internist, Toronto Western Hospital, and assistant professor, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
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Goulart MF, Huayllani MT, Balch Samora J, Moore AM, Janis JE. Assessing the Prevalence of Microaggressions in Plastic Surgery Training: A National Survey. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2021; 9:e4062. [PMID: 34963876 PMCID: PMC8694515 DOI: 10.1097/gox.0000000000004062] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 11/19/2021] [Indexed: 11/25/2022]
Abstract
There has been increased awareness of microaggressions occurring during medical training. However, the prevalence and characteristics of microaggressions specifically in plastic surgery residency remain unknown. We aimed to fill this literature gap by conducting a nationwide survey to better understand and characterize microaggressions in plastic surgery training. METHODS A survey was distributed between March and May 2021 via the American Society of Plastic Surgeons Resident Representatives to 1014 integrated and 214 independent track plastic surgery trainees in the United States. Multiple Pearson's chi-square of independence and Fisher exact tests evaluated comparisons of microaggressions by sex, race, Hispanic origin, sexual orientation, and year in training. A multivariate regression analysis assessed associations between variables. RESULTS One hundred twenty-five participants responded to the survey (response rate: 10.2%). Of those who responded, 68.8% had experienced microaggressions in the past year. Female trainees experienced microaggressions more frequently than male trainees (P < 0.05). Asian trainees had higher odds to be a target of microaggressions compared with White trainees (P = 0.013). Nonheterosexual trainees were more likely to have experienced microaggressions compared with heterosexual trainees (P < 0.05). Independent trainees were more likely to experience microaggressions than PGY 1-2 and 3-4 integrated residents (P < 0.05). CONCLUSIONS Approximately seven in every 10 trainees stated that they experienced microaggressions in the past year. Females, racial minorities, sexual minorities, and independent trainees had higher odds of reporting that they experienced microaggressions. Further studies are needed to assess the implementation of strategies that address this problem to resolve inequities.
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Affiliation(s)
- Micheline F. Goulart
- From the Department of Plastic and Reconstructive Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Maria T. Huayllani
- From the Department of Plastic and Reconstructive Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Julie Balch Samora
- Nationwide Children’s Hospital, The Ohio State University, Columbus, Ohio
| | - Amy M. Moore
- From the Department of Plastic and Reconstructive Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Jeffrey E. Janis
- From the Department of Plastic and Reconstructive Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio
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Sanfey H. Invited Commentary: Gender-Based Microaggressions in Surgery: A Scoping Review of the Literature. World J Surg 2021; 45:1423-1424. [PMID: 33598725 DOI: 10.1007/s00268-021-06004-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/31/2021] [Indexed: 10/22/2022]
Affiliation(s)
- Hilary Sanfey
- Southern Illinois University School of Medicine, Springfield, USA.
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