Why are women deterred from general surgery training?

Pregnancy and infertility in orthopedics: A review of the current state

BACKGROUND

Orthopedic surgery continues to have one of the lowest rates of female trainees among all medical specialties in the United States. Barriers to pursuing a surgical residency include the challenges of family planning and work-life balance during training.

METHODS

A systematic literature search of articles published between June 2012 and December 2022 in the MEDLINE, EMBASE, and Cochrane databases was performed in January 2023 according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis). Studies were included if they evaluated pregnancy and peripartum experience and/or outcomes amongst orthopedic surgeons or trainees.

RESULTS

Eighteen studies were included. Up to 67.3% of female orthopedic surgeons and trainees and 38.7% of their male counterparts delayed childbearing during residency. The most reported reasons for this delay included career choice as an orthopedic surgeon, residency training, and reputational concerns among faculty or co-residents. Infertility ranged from 17.0% to 30.4% in female orthopedic surgeons and up to 31.2% suffered obstetric complications. Assisted Reproductive Technology (ART) resulted in 12.4%-56.3% of successful pregnancies. Maternity and paternity leaves ranged from 1 to 11 weeks for trainees with more negative attitudes associated with maternal leave.

CONCLUSIONS

Female orthopedic trainees and attending delay childbearing, experience higher rates of obstetric complications, and more stigma associated with pregnancy compared to their male colleagues. Program and institutional policies regarding maternity and paternity leave are variable across programs, and therefore, attention should be directed toward standardizing policies.

Gender trends in match rate to surgical specialties in Canada: A retrospective study from 2003-2022

BACKGROUND

In Canada, there is a recognized underrepresentation of women in the field of surgery. However, the extent to which this trend applies across various surgical specialties is not well delineated. The aim of this study is to identify existing disparities and trends over time to inform the need for future interventions to make the match process more equitable for applicants.

METHODS

Data regarding surgical specialty applicants was extracted from the Canadian Resident Matching Service (CaRMS)'s 2003 to 2022 reports.

RESULTS

A total of 9,488 applicants ranked surgical specialties as their first choice from 2003-2022. Increases in the proportion of women applicants comparing periods 2003-2007 to 2018-2022 were significant for cardiac surgery (22% to 43%, p = 0.03), general surgery (46% to 60%, p<0.001), orthopedic surgery (23% to 35%, p<0.001), urology (23% to 38%, p<0.001), and all aggregated surgical specialties ('all surgery') (45% to 55%, p<0.001). An increase in the proportion of women applicants who matched over the same periods was observed for general surgery (+47% to 60%, p<0.001), orthopedic surgery (24% to 35%, p<0.01), urology (21% to 34%, p<0.001), and all surgery (46% to 54%, p<0.001). From 2003-2022, a lower match rate for women compared to men was observed for otolaryngology (0.60 v 0.69, p = 0.008), urology (0.61 v 0.72, p = 0.003), and all surgery (0.71 v 0.73, p = 0.038), while higher match rates were observed for ophthalmology (0.65 v 0.58, p = 0.04). No statistically significant differences in match rate were observed from 2018-2022.

CONCLUSIONS

While the proportion of women applicants to surgical specialties in Canada has been increasing, women remain underrepresented in several surgical specialties. This underrepresentation cannot be solely attributed to fewer women applying to these specialties, as women experience lower success rates when matching to specific surgical specialties. Further research is essential to identify and address the underlying causes of these disparities.

Ergonomic Assessment of Septorhinoplasty Maneuvers During Simulated Pregnancy

Objective

Women represent an increasing proportion of the otolaryngology workforce. Work-related musculoskeletal disorders (WRMSD) are a little-studied yet important impediment to career completion. Scant attention has been directed to study the impact of pregnancy on surgeon posture and ergonomics. We piloted the use of a pregnancy simulation suit (Empathy Belly) to assess the risk of ergonomic compromise when performing open septorhinoplasty.

Study Design

Surgical simulation.

Setting

Single session, training simulation lab at academic medical center.

Methods

Medical students and surgical residents performed the initial steps of a rhinoplasty procedure without and with a pregnancy simulation suit and were filmed with an artificial intelligence-based video analysis app from Kinetica Labs that calculates joint angles and categorizes the ergonomic risk factors. Still images from videos were taken and analyzed using validated posture-based analysis rubrics. Participants were asked to complete a qualitative questionnaire after the session.

Results

Twelve medical students and surgical residents participated in the study. Posture-based analysis indicated increased ergonomics risk factors among trainees when performing a rhinoplasty while wearing the pregnancy suit. Video analysis indicated trends of worsening back angle and shoulder postures. Trainees reported experiencing pain in the neck, suprapubic area, and lower back. They acknowledged the importance of ergonomics in otolaryngology and desired further education about workplace injury risk mitigation.

Conclusion

Pregnancy impacts the ergonomics of performing septorhinoplasty and further investigation is required into interventions to reduce risk of WRMSDs.

Gender trends in Canadian medicine and surgery: the past 30 years

BACKGROUND

While the number of women entering medicine has steadily increased since the 1970s in Canada, the gender composition along each stage of the medical training pathway has not been comprehensively reported. We therefore sought to systematically examine the gender composition of students, residents, and practicing physicians over the past 30 years in Canada.

RESULTS

In this cross-sectional analysis of Canadian medical trainees including MD applicants (137,096 male, 169,099 female), MD students (126,422 male, 152, 967 female), MD graduates (29,413 male, 34,173 female), residents by the decade (24,425 male, 28,506 female) and practicing surgeons (total 7,457 male, 3,457 female), we find that increased female representation in medicine is not matched by representation in surgery, with the key being the specialty choice process. The likelihood of female applicants matriculating to medical school was less than male applicants in the 90s (OR 0.92, 95% CI 0.92-0.93), greater in the early 2000s (OR 1.03, 95% CI 1.03-1.04), and has since balanced out (OR 1.00, 95% CI 1.00-1.01), with medical school classes being nearly 60% female for the past two decades. Despite this, females have remained underrepresented in most surgical residency programs, with odds of female medical students entering surgical residency other than Ob/Gyn being about half that of male students (OR 0.56, 95% CI 0.44-0.71), resulting in a slow increase in practicing female surgeons of less than 0.5% per year in many surgical disciplines and projected parity decades or centuries in the future.

CONCLUSIONS

While undergraduate medical education has been majority female in Canada for nearly three decades, females remain greatly underrepresented in the physician workforce within surgical specialties. To build a representative medical workforce equipped to care for diverse patient populations, factors influencing the specialty choices of early career physicians will need to be examined and addressed.

The gender role in the publishing of Authorships in high-impact orthopedic journals

To evidence the existence of a gender gap in the orthopedic scientific literature by including also differences between some specific orthopedic surgery specialities, such as hands and feet. Then, we also considered gender role in the Authorship linked with the economic wealth of each country belonging to each Author. The gender of the first Authors of journals on orthopedics and sports medicine indexing in the Scopus database with the highest impact factor (IF) related to the year 2019, for the period from January 1, 2015, to December 31, 2020, were considered. A total of 11 journals were considered, including a total of 5474 articles, 1087 (19.86%) had a woman as the first Author and 4387 (80.14%) a man. During the studied period, the trend seems to be the same (p = 0.906): Men were significantly more producing than women in the orthopedic field both by considering the topic of the journal (p = .003), all the most impacted orthopedic journals (p < 0.001) and economies (p < 0.001). There was therefore a strong significance: In the orthopedic field, there were significantly more male researchers who presented their first name in scientific publications compared to females in all orthopedic subspecialties. The economically poorer countries published less and the role of women became almost absent.

Can Mentorship Shatter the Glass Ceiling in Academic Microsurgery? A National Survey of Microsurgery Fellowship-Trained Women

BACKGROUND

The "leaky pipeline" phenomenon has caused women to remain underrepresented at higher levels of academic plastic surgery. No study has considered the availability of mentorship within any subset of academic plastic surgery. The purpose of this study was to evaluate the current representation of women in academic microsurgery and to determine the impact of mentorship on career progression.

METHODS

An electronic survey was designed to determine the availability and quality of mentorship respondents received at different stages of their career (from medical student to attending physician). The survey was distributed to women who completed a microsurgery fellowship and were current faculty at an academic plastic surgery program.

RESULTS

Twenty-seven of 48 survey recipients participated (56.3% response rate). Most held an associate professor (20.0%) or assistant professor (40.0%) position. Respondents had an average of 4.1 ± 2.3 mentors throughout their entire training. A minority of mentors were microsurgery trained (28.3%), and only 29.2% of respondents reported female mentorship throughout their training. Attending physicians least often received formative mentorship (52.0%). Fifty percent of respondents sought female mentors, citing that they desired female insight. Of those who did not seek female mentors, 72.7% cited a lack of access to female mentors.

CONCLUSIONS

Evidenced by female trainees being unable to find female mentors and low rates of mentorship at the attending physician level, there is currently not enough capacity to meet the demand for female mentorship by women pursuing academic microsurgery. Many individual and structural barriers to quality mentorship and sponsorship exist within this field.

Evaluating Diversity Promotion on Integrated Plastic Surgery Residency Program Websites and Instagram Accounts

BACKGROUND

Medical students applying to residency, including those from underrepresented groups, strongly value cultural fit and program diversity. Program websites and social media are thus an influential information source for prospective applicants and recruitment tool for residencies. We evaluated whether and how integrated plastic surgery residency program websites and social media display commitments to diversity online.

METHODS

We evaluated program websites for 8 predetermined diversity elements, (1) nondiscrimination and (2) diversity statements, (3) community resources, (4) faculty and (5) resident biographies, (6) faculty and (7) resident photographs, and (8) resident resources, and assessed Instagram accounts for diversity-related images, captions, and hashtags. Our analysis used Mann-Whitney U , chi-squared, and t tests; significance level was P < 0.05.

RESULTS

We reviewed 82 program websites with a mean of 3.4 ± 1.4 diversity elements. Resident (n = 76, 92.7%) and faculty photographs (n = 65, 79.3%) and resident biographies (n = 43, 52.4%) were the most common. Seventy programs (85.4%) had Instagram accounts, the majority of which (n = 41, 58.6%) shared content related to diversity in race, ethnicity, gender, and/or sexual orientation. Programs located in smaller cities were more likely to have ≥4 website diversity elements ( P = 0.014) and mention diversity on Instagram ( P = 0.0037). Programs with women chairs/chiefs were more likely to mention diversity on Instagram ( P = 0.007).

CONCLUSIONS

In the age of virtual recruitment, program websites and social media should provide sufficient information, described in our diversity element checklist, to help prospective applicants determine fit from a diversity perspective. Residents, who often contribute to program social media, and women chairs/chiefs may be critical to driving diversity promotion.

Surgical Education: Disparities in Education May Impact the Quality and Likelihood of Completion of Training

Female surgical trainees experience bias that begins at the preclinical stages of medical school, extending into their surgery clerkships, and then into their residency training. There are important implications in terms of training opportunities and career advancement, mentorship, sponsorship, and ultimately burnout. Childbearing and lactation also impact the experiences and perceptions of female trainees who have children. There are limited interventions that have improved the experience of women in surgical training. Mentorship appears to play an important role in ameliorating some of the negative consequences of the training environment and improving outcomes for women surgeons.

The Role of Gender-Concordant Mentorship in Women Premedical Students' Perception and Pursuit of Surgical Careers

OBJECTIVE

Evaluate the impact of a 6-month structured mentorship program between women premedical student mentees paired with women medical students and surgical residents on mentees' interests and perceptions of surgical careers.

DESIGN

Prospective qualitative and quantitative study.

SETTING

This study took place at the Boston University School of Medicine, a single institution tertiary care hospital.

PARTICIPANTS

Self-identified women premedical students at Boston University were eligible for inclusion in this program (n=90). Participants were recruited and grouped with self-identified women medical student (n=52) and resident (n=19) mentors. Participants were provided with a monthly curriculum to guide discussions. Mentees completed pre- and postprogram surveys with 5-point Likert scale questions regarding interest and exposure to surgery, role models and mentorship, and effect of COVID-19 on their career interests. Pre- and postprogram responses were compared using a Wilcoxon rank sum test.

RESULTS

Of the 90 mentees, 63 (70%) completed preprogram surveys, and 53 (59%) completed postprogram surveys. Survey respondents indicated statistically significant increased exposure to positive role models (preprogram mean 3.15, postprogram mean 4.06, p=0.0003), increased exposure to women role models (preprogram 2.30, postprogram 3.79, p<0.0001), increased access to dedicated mentors (preprogram 2.11, postprogram 3.75, p<0.0001), and increased availability of support persons to answer their questions and concerns about careers in surgery (preprogram 3.03, postprogram 3.85, p=0.001). There was also a statistically significant increase in the reported effect that exposure to gender-concordant role models in surgery had on participants' decisions to consider a surgical career (preprogram 3.58, postprogram 4.23, p=0.001).

CONCLUSION

This 6-month structured mentorship program for undergraduate premedical students increased mentees' exposure to positive women role models and mentors, and increased mentee's interest in pursuing a surgical career. This emphasizes the need for structured gender-concordant mentorship programs early in women's careers to encourage pursuit of surgical careers in an otherwise men-dominated field.

The Challenges of Parenthood for Female Surgeons: The Current Landscape and Future Directions

Although surgical training programs have nearly reached gender parity, pregnancy and parenthood remain challenging for female surgeons, with obstetric risks related to occupational demands, stigma, inconsistent and brief parental leaves, a paucity of postpartum support for lactation and childcare, and little mentorship on work-family integration. This work environment causes many to postpone starting a family, which leads to higher risks of infertility among female surgeons compared to their male peers. Perception of work-family incompatibility jeopardizes recruitment and retention of our surgical workforce, as it deters medical students from the profession, increases risk of resident attrition, and leads to burnout and career dissatisfaction. The challenges of parenthood for female surgeons was the focus of a Hot Topics session during the 2022 Academic Surgical Congress, the discussion of which is presented herein with recommendations for policy change to better support maternal-fetal health and the needs of surgeons with young children.

Women as a driver to address gaps in the global surgical workforce

Five billion people around the world lack access to safe and affordable surgical, anaesthetic, and obstetric care. There is a link between countries in which women are underrepresented in the surgical workforce and those struggling to meet their surgical need. In this commentary article, the underrepresentation of women in low- and middle-income country's (LMIC) surgical workforce is discussed. It is argued that the issue is self-reinforcing. On one hand, active change requires a sufficient number of female surgeons to initiate it. On the other, women can only start to penetrate the surgical workforce once they are safe, healthy, and motivated enough to do so, in turn depending on the presence of female surgeons to advocate for their female patients and empower future generations of young girls and women.

The impact of gendered experiences on female medical students' specialty choice: A systematic review

BACKGROUND

Women make up 50% of American medical school graduates, yet are not equally represented in the vast spectrum of medical specialties. Many fields within medicine remain male dominated. This systematic review will explore social factors that affect female medical students' specialty choice.

HYPOTHESIS

Gendered experiences influence the specialty choice of female medical students, resulting in their concentration in a specific cohort of specialties.

METHODS

Studies were gathered by searching MEDLINE/Pubmed and EBSCOhost for sociological factors that impact female medical students' specialty choice.

RESULTS

34 articles were selected for this systematic review. Factors that contribute to gender segregation within medical specialties include gender discrimination, socialization, lifestyle considerations, negative perceptions of male-dominated medical specialties and lack of female role models.

CONCLUSION

This systematic review supported the hypothesis that gendered experiences impact women's medical specialty choice, and thus result in their concentration in specialties such as family medicine, pediatrics and obstetrics and gynecology.

Is student mentoring career-defining in surgical disciplines? A comparative survey among medical schools and medical students for mentoring programs

Objective

Facing a shortage of young surgeons, this study aimed to examine the availability of mentoring programs and if this can counteract this lack.

Summary background data

Medical mentoring programs have proven to be decisive to influence students' later career decisions. Since their structure may depend on the medical school and the effort of single disciplines, the offers are often very heterogeneous.

Methods

Anonymous online-questionnaires were developed and distributed among medical students in Germany and the dean for teaching of the medical schools from July 2019 to January 2020 in Germany. Data of the availability of mentoring programs, their structure and the impact of surgery were collected.

Results

Forty three medical schools participated, with 65% offering mentoring programs. 18 of medical schools had no additional funding available for this. Surgical subjects participated in these programs in only 30%. Additionally, 1,516 medical students participated in the second survey. A total of 70% had already participated in a mentoring program with a significantly higher proportion of men. Of these, 94% stated that this was helpful and had an impact on their career planning, without any gender differences. 95% would participate in structured surgical mentoring programs and 95% agreed that this could have an impact on their career planning.

Conclusion

Mentoring programs may be able to influence career planning, nevertheless participation by surgical specialties has been low. Becoming more active in providing mentoring programs with a special focus on women and offering more surgical content can be a way to counteract the lack of surgical trainees.

Wake up to the gender gap in academic anesthesiology and address the pipeline

Diversity, equity, and inclusion are important values in health care and academic medicine. Although women have comprised nearly 50% of all US medical school graduates since the early 2000s, gender disparities continue in many specialties and persist in medical education leadership. For women in anesthesiology, gender inequities exist along the academic pipeline, with greater disparity in the higher ranks of academia and leadership. Successful endeavors to improve gender equity in the specialty include increasing awareness, engaging in faculty development, and encouraging transparent promotions processes. The strides will be short and change will be slow unless we shift focus to when the gender imbalance begins-at the transition from undergraduate medical education to graduate medical education. Currently women comprise 37% of academic anesthesiology faculty; however, the current resident pool is only 33% women. If recruitment of a gender-equitable workforce at the undergraduate-to-graduate medical education transition is not a priority, the downstream measures will have minimal impact toward gender equity in academic anesthesiology.

Early Barriers to Career Progression of Women in Surgery and Solutions to Improve Them: A Systematic Scoping Review

OBJECTIVE

This study aims to summarize the evidence concerning the barriers that exist to the career progression of women in surgery and to provide potential solutions to overcome these obstacles.

BACKGROUND

Visible and invisible impediments can hinder female doctors' pursuit of a surgical career, from choosing a surgical specialty to training opportunities and all the way through career progression.

METHODS

Database search of original studies about barriers for female surgeons during choice of surgical career, residency, and career progression. A query including possible solutions such as mentorship and network was included.

RESULTS

Of 4618 total articles; 4497 were excluded as duplicates, having incorrect study focus, or not being original studies; leaving 120 studies meeting the inclusion criteria. Of the articles included, 22 (18%) focused on factors affecting the pursuit of a surgical career, such as surgical work hours and limited time for outside interests, 55 (46%) analyzed the main barriers that exist during surgical residency and fellowship training, such as discrimination and sexual harassment, 27 (23%) focused on barriers to career advancement, heavy workloads, ineffective mentorship, unclear expectations for advancement, inequality in pay or work-home conflicts. Among studies reporting on possible solutions, 8 (6.5%) articles reported on the role of effective mentorship to support career advancement and to provide moral support and 8 (6.5%) on the emerging role of social media for networking. Our analysis showed how different impediments hinder surgical career progression for women, with notable consequences on burnout and attrition.

CONCLUSIONS

Identification and recognition of obstacles to career progression is the first step to addressing the gender gap in surgery. Active strategies should be improved to promote a culture of diversity and to create equal opportunity for women in surgery, while implementing structured mentoring programs and investing on an adequate communication on social media to engage the future generations.

Role of Female Research at the Asociacion Mexicana de Cirugia General Annual Meeting: A Retrospective Analysis From 2013 to 2019

Background

Academic surgery has been a traditionally male-dominated field. Female contribution remains challenging. In Mexico, there is no published evidence regarding gender disparity in academic surgery. We aimed to analyze the female role in clinical research submitted to the Asociación Mexicana de Cirugía General (AMCG).

Methods

Retrospective study evaluating abstracts submitted to AMCG annual meetings from 2013 to 2019. Categorical variables were compared using χ² test. Univariate logistic regression was performed to calculate odds ratios (OR) followed by a log-binomial logistic regression model to obtain the adjusted relative risk (aRR) for acceptance as an oral presentation.

Results

Overall, 7,439 abstracts were analyzed of which 24.2% were submitted by females. Female-submitted abstracts increased from 22.5% to 25.3% during 2013–2019 (p = 0.15). The proportion of 47 abstracts submitted by females was higher in the resident group (27.7% vs. 18.8%; p < 0.001). The percentage of females’ abstracts selected for oral presentation was less than the percentage of males’ 49 abstracts selected for presentation (9% vs. 11.5%; p = 0.002). Females’ abstracts submitted have a 50 23.5% decreased chance of being selected for oral presentation (OR = 0.765, CI 95%, 0.639–0.917, 51 p = 0.003). However, after adjusting for research type and trainee status, the gender of the oral 52 presenting author showed no association (aRR = 0.95, CI 95%, 0.8–1.1, p = 0.56).

Conclusion

In Mexico, the female role in academic surgery is still limited. These results should 55 encourage professors and program directors to identify and address factors contributing to gender 56 disparities.

Factors Influencing the Intention to Pursue Surgery among Female Pre-Medical Students: A Cross-Sectional Study in Pakistan

BACKGROUND

While gender disparities in surgery are documented worldwide, it is unclear to what extent women consider surgery as a career before embarking on their medical school journey. This study aimed to report the percentage of pre-medical women in Pakistan who intend to eventually specialize in surgery and assess the factors motivating and deterring this decision.

METHODS

An online survey was conducted among female pre-medical (high school) students across Pakistan. Multivariable logistic regression was performed to determine motivating and deterring factors associated with the intention to pursue surgery.

RESULTS

Out of 1219 female high-school students, 764 (62.7) intended to join medical school. Among these 764, only 9.8% reported an exclusive intent to pursue surgery, while just 20.3% reported considering other specialties in addition to surgery. Significant motivators to pursue surgery exclusively were the intellectual satisfaction of pursuing surgery (adjusted odds ratio: 2.302), having opportunities to travel internationally for work (2.300) and use cutting-edge technology (2.203), interest in the specialty of surgery (2.031), the social prestige of becoming a surgeon (1.910), and considering one's personality well-suited to surgery (1.888). Major deterrents included the lack of interest in surgery (adjusted odds ratio: 3.812), surgical education and training being too difficult (2.440) and lengthy (1.404), and the risk of aggressive behavior from patients (2.239).

CONCLUSION

Even before entering medical school, most female pre-medical students have already decided against considering a future surgical career. Deterrents likely stem from women being pressured to conform to deep-seated societal expectations to dedicate their time and energy to domestic responsibilities.

Gender Disparities Among Craniofacial Surgeons

To delineate career differences between genders of practicing plastic surgeons who have completed craniofacial fellowship given the known disparities in surgeons' professional and personal lives and an already lengthy residency training, there is concern that less women may commit to further fellowship training.

Craniofacial fellowship programs were contacted to identify graduates and an internet search was attempted where information was not available. Surgeon profiles and literature databases were used to obtain practice demographics and publications.

Accredited fellowships were identified through the American Society of Craniofacial Surgeons directory.

Program responses along with internet searches identified 201 graduates from 26 programs, of which 132 (66%) were men and 69 (34%) were women. On average, male graduates had 7.1 years in practice versus 6.6 years for females graduates (P = .176). There were significant differences between average number of publications (24.7 publications for males vs 14.1 for females, P = .009) and academic practice (46% males vs 64% females, P = .018). A similar percentage of males and females held leadership positions (13% males vs 16%, P = .552).

Despite similar years in practice, men had significantly higher publications while women were significantly more likely to practice in an academic setting. Females are increasing their representation in academia and leadership within the craniofacial community. However, efforts must still be directed at increasing exposure to craniofacial surgery and supporting research and leadership pursuits earlier on during their careers.

Women Surgeons in Brazil: A Time Trend Analysis by Specialties in the Last Decade

BACKGROUND

In surgery, there is a gender worldwide gap. In Brazil, we still do not have studies that describe this scenario. Based on this lack of research, we aim to assess the prevalence of women in surgical specialties, how it has changed over the years and how long it will take to achieve an equal distribution of men and women surgeons in Brazil.

METHODS

We conducted a retrospective review of the last five editions of the Brazilian Medical Demography (2011, 2013, 2015, 2018, and 2020). We analyzed the absolute and proportional (women/total) increase in women registered in 13 surgical specialties in Brazil. We performed a linear regression, and we estimated the expected year of equal distribution of women and men in each subspecialty, through the linear regression equation.

RESULTS

In absolute numbers of women, all surgical specialties presented a linear increase over the years (p <.05). In proportional numbers of women, however, 10 specialties showed a significant linear increase (p <.05) except cardiovascular surgery, hand surgery, and neurosurgery. According to the equation that predicts equal distribution, pediatric surgery will be the first one to achieve equal distribution, in 2026, and other specialties are far from achieving it. For example, Urology will not achieve equal distribution until 2433.

CONCLUSIONS

There are fewer women surgeons in Brazil than men. However, in general, there is an increase in women in the analyzed specialties over the years. With the proportional inclusion of women in the Brazilian surgical workforce, we hope that we can achieve sex equality in Brazil.

Evolution of Gender Disparities Among Brazilian Surgical, Anesthesia, and Obstetric Providers

INTRODUCTION

Since 2010, most graduating physicians in Brazil have been female, nevertheless gender disparities among surgical specialties still exist. This study aims to explore whether the increase in female physicians has translated to increased female representation among surgical specialties in Brazil.

METHODS

Data on gender, years of practice, and specialty was extracted from Demografia Médica do Brasil, from 2015 to 2020. The percentage of women across 18 surgical, anesthesia, and obstetric (SAO) specialties and the relative increases in female representation during the study period were calculated.

RESULTS

Of the 18 SAO specialties studied, 16 (88%) were predominantly male (>50%). Only obstetrics/gynecology and breast surgery showed a female predominance, with 58% and 52%, respectively. Urology, neurosurgery, and orthopedic surgery and traumatology were the three specialties with the largest presence of men - and the lowest absolute growth in the female workforce from 2015 to 2020.

CONCLUSIONS

In Brazil, where significant gender disparities persist, women are still underrepresented in surgical specialties. Female presence is predominant in surgical specialties dedicated to the care of female patients, while it remains poor in those with male patient dominance. Over the last 5 y, the proportion of women working in SAO specialties has grown, but not as much as in nonsurgical specialties. Future studies should focus on investigating the causes of gender disparities in Brazil to understand and tackle the barriers to pursuing surgical specialties.

Bullying, Discrimination, Harassment, Sexual Harassment, and the Fear of Retaliation During Surgical Residency Training: A Systematic Review

BACKGROUND

The negative effects of bullying, discrimination, harassment, and sexual harassment (BDHS) on well-being and productivity of surgical residents in training have been well documented. Despite this, little has changed over the past decade and these behaviors continue. The purpose of this study was to determine the prevalence of each abusive behavior experienced by residents, identify the perpetrators, and examine the reporting tendency.

METHODS

A systematic review of articles published between 2010 and 2020 in the MEDLINE, EMBASE, and Cochrane databases was performed following PRISMA guidelines. The following search terms were used: bullying, harassment, sexual harassment, discrimination, abuse, residency, surgery, orthopedic surgery, general surgery, otolaryngology, obstetrics, gynecology, urology, plastic surgery, and training.

RESULTS

Twenty-five studies with 29,980 surgical residents were included. Sixty-three percent, 43, 29, and 27% of surgical residents experienced BDHS, respectively. Female residents reported experiencing all BDHS behaviors more often. Thirty-seven percent of resident respondents reported burnout, and 33% reported anxiety/depression. Attending surgeons, followed by senior co-residents, were the most common perpetrators. Seventy-one percent did not report the behavior to their institution. Fifty-one percent stated this was due to fear of retaliation. Of those who reported their experiences, 56% stated they had a negative experience reporting.

CONCLUSION

Our review demonstrates high prevalence rates of BDHS experienced by residents during surgical training, which have been associated with burnout, anxiety, and depression. The majority of residents did not report BDHS due to fear of retaliation. Residency programs need to devise methods to have a platform for residents to safely voice their complaints.

Discrimination of residents during neurosurgical training in Mexico: Results of a survey prior to SARS-CoV-2

Background:

Recent severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic represents an important negative impact on global training of neurosurgery residents. Even before the pandemic, discrimination is a challenge that neurosurgical residents have consistently faced. In the present study, we evaluated discriminatory conditions experienced by residents during their neurosurgical training in Mexico before the SARS-CoV-2 pandemic.

Methods:

An electronic survey of 18 questions was sent among residents registered in the Mexican Society of Neurological Surgery (MSNS), between October 2019 and July 2020. Statistical analysis was made in IBM SPSS Statistics 25. The survey focused on demographic characteristics, discrimination, personal satisfaction, and expectations of residents.

Results:

A response rate of 50% (132 of 264 residents’ members of MSNS) was obtained and considered for analysis. Median age was 30.06 ± 2.48 years, 5.3% (n = 7) were female and 16.7% (n = 22) were foreigners undergoing neurosurgical training in Mexico. Approximately 27% of respondents suffered any form of discrimination, mainly by place of origin (9.1%), by gender (8.3%) or by physical appearance (6.1%). About 42.9% (n = 3) of female residents were discriminated by gender versus 6.4% (n = 8) of male residents (P = 0.001); while foreign residents mentioned having suffered 10 times more an event of discrimination by place of origin compared to native Mexican residents (36.4% vs. 3.6%, P < 0.001).

Conclusion:

This manuscript represents the first approximation to determine the impact of discrimination suffered by residents undergoing neurosurgical training in Mexico before the SARS-CoV-2 pandemic.

Moving the Needle: Directed Intervention by the American Society for Surgery of the Hand Is Effective in Encouraging Diversity in Expert Panel Composition

Purpose

Recent efforts have been made by the American Society for Surgery of the Hand to encourage female inclusion in expert panels. We hypothesized that female representation on expert panels has increased over the past decade and that a directed intervention by the American Society for Surgery of the Hand would be associated with an increased percentage of submissions with female panelists.

Methods

We performed a retrospective analysis of Instructional Course Lecture and Symposium submissions for the 2011 through 2021 American Society for Surgery of the Hand Annual Meetings. Authorship was reviewed, and the gender of the proposed authors was recorded. Additionally, the status of “all-male panel” was attributed to panels with no proposed female authors. Submissions were reviewed and compared with meeting programs to determine the status of accepted or rejected. Longitudinal analysis was performed to determine trends in the gender composition of expert panels.

Results

In total, 1,687 submissions were reviewed, including 1,323 Instructional Course Lectures and 364 Symposia. Female authorship constituted 18% of authorship (1,170/6,663), and lead authorship was similarly distributed, with 18% being female (296/1,687). Overall, female representation has increased steadily over the past decade, with females constituting 13% (43/332) and 20% (163/818) of the submitted authors in 2011 and 2020, respectively. Similarly, all-male panels declined from 74% (76/103) to 46% (85/185) of panels over the same timeframe. Most strikingly, a sharp increase in gender representation was observed with the directed intervention noted in the 2021 Call for Abstracts, resulting in an increase in female authorship to 26% (295/1,124) and a decline in all-male panels to 29% (70/241).

Conclusions

Gender representation among hand surgery expert panels moved toward increased equity over the past decade, which has been aided by directed interventions.

Clinical relevance

Career development and trainee decision making are impacted by gender representation; directed and intentional interventions by professional organizations are effective in encouraging greater equity and diversity within the field.

Persistence of Gender Bias Over Four Decades of Surgical Training

OBJECTIVE

Female surgeons face gender-specific obstacles during residency training, yet longitudinal data on gender bias experienced by female surgery residents are lacking. We aimed to investigate the evolution of gender bias, identify obstacles experienced by female general surgery residents, and discuss approaches to supporting female surgeons during residency training.

METHODS

Between August 2019 and January 2021, we conducted a retrospective cohort study using structured telephone interviews of female graduates of the UCLA General Surgery Residency training program. Responses of early graduates (1981-2009) were compared with those of recent graduates (2010-2020). Quantitative data were compared with Fisher's exact tests and Chi-squared tests. Interview responses were reviewed to catalog gender bias, obstacles experienced by female surgeons, and advice offered to training programs to address women's concerns.

RESULTS

Of 61 female surgery residency graduates, 37 (61%) participated. Compared to early graduates (N = 20), recent graduates (N = 17) were significantly more likely to pursue fellowship training (100% vs. 65%, p < 0.01) and have children before or during residency (65% vs. 25%, p = 0.02). A substantial proportion in each cohort experienced some form of gender bias (71% vs. 85%, p = 0.43). Compared to early graduates, recent graduates were significantly less likely to report experiencing explicit gender bias (12% vs. 50%, p = 0.02) but equally likely to report implicit gender bias (71% vs. 55%, p = 0.50). Female graduates across the decades advocated for specific measures to champion work-life balance in residency (51%), strengthen female mentorship (49%), increase childcare support (41%), and promote women into leadership positions (32%).

CONCLUSIONS

While having children during residency has become more common and accepted over the decades, female surgery residents continue to experience implicit gender bias in the workplace. Female surgeons advocate for targeted interventions to establish systems for parental leave, address gender bias, and strengthen female mentorship.

A National Survey on the characteristics of Iranian General Practitioners and Their Preferred Specialty: A Need to Transition toward Preventive Medicine

Background:

The shortage and unbalanced distribution of physicians has adverse effects on the provision of equitable services at all levels of health care and especially at the prevention and primary care levels. The choice of specialty can seriously change the structure and composition of the physician workforce. Therefore, this study aimed to investigate the relationship between background characteristics of Iranian general practitioners' (GPs) and their preferred specialty fields.

Methods:

In this mixed-method study, first, 12 medical doctors participated in a nominal group technique to determine the most important background characteristics that affect GPs' preferences for specialty selection. In the second phase, we conducted a survey among 680 GPs in six provinces from different geographic regions. We gathered data using a researcher-made checklist and analyzed them using an adjusted multivariate regression.

Results:

The adjusted analysis showed that being female, being married, being in an older age group, having children, graduation from universities located in the provincial centers, and decision for living and practicing in the less-populated areas were significantly associated with the Iranian GPs' preferences for non-surgical specialties.

Conclusions:

This study provided evidence that could inform national health workforce policy-makers to avoid unbalanced distribution of physicians and accordingly to ensure the provision of equitable services at all levels of healthcare and especially at the primary care level. Other effective factors on the selection of specialty should be evaluated at the national level using specific surveys and econometrics studies such as discrete selection experiment to move toward preventive medicine.

Gender Disparities Among Burn Surgery Leadership

Gender disparities have been described in the plastic surgery and general surgery literature, but no data have been reported in burn surgery. The aim of this study is to determine gender disparities among burn surgery leadership. A cross-sectional study was performed. Burn surgeons included were directors of American Burn Association (ABA)-verified burn centers, past presidents of the ABA, and International Society for Burn Injuries (ISBI), and editors of the Journal of Burn Care & Research, Burns, Burns & Trauma, Annals of Burns & Fire Disasters, and the International Journal of Burns and Trauma. Training, age, H-index, and academic level and leadership position were compared among surgeons identified. Among the 69 ABA and ISBI past presidents, 203 burn journals' editorial board members, and 71 burn unit directors, females represented only 2.9%, 10.5%, and 17%, respectively. Among burn unit directors, females completed fellowship training more recently than males (female = 2006, male = 1999, P < .02), have lower H-indexes (female = 8.6, male = 17.3, P = .03), and are less represented as full professors (female = 8.3%, male = 42.4%, P = .026). There were no differences in age, residency, research fellowship, or number of fellowships. Gender disparities exist in burn surgery and are highlighted at the leadership level, even though female surgeons have a similar age, residency training, and other background factors. However, gender diversity in burn surgery may improve as females in junior faculty positions advance in their careers.

Global parental leave in surgical careers: differences according to gender, geographical regions and surgical career stages

BACKGROUND

There is a lack of information regarding the provision of parental leave for surgical careers. This survey study aims to evaluate the experience of maternity/paternity leave and views on work-life balance globally.

METHODS

A 55-item online survey in 24 languages was distributed via social media as per CHERRIES guideline from February to March 2020. It explored parental leave entitlements, attitude towards leave taking, financial impact, time spent with children and compatibility of parenthood with surgical career.

RESULTS

Of the 1393 (male : female, 514 : 829) respondents from 65 countries, there were 479 medical students, 349 surgical trainees and 513 consultants. Consultants had less than the recommended duration of maternity leave (43.8 versus 29.1 per cent), no paid maternity (8.3 versus 3.2 per cent) or paternity leave (19.3 versus 11.0 per cent) compared with trainees. Females were less likely to have children than males (36.8 versus 45.6 per cent, P = 0.010) and were more often told surgery is incompatible with parenthood (80.2 versus 59.5 per cent, P < 0.001). Males spent less than 20 per cent of their salary on childcare and fewer than 30 hours/week with their children. More than half (59.2 per cent) of medical students did not believe a surgical career allowed work-life balance.

CONCLUSION

Surgeons across the globe had inadequate parental leave. Significant gender disparity was seen in multiple aspects.

Women in Leadership and Their Influence on the Gender Diversity of Academic Plastic Surgery Programs

BACKGROUND

Women seldom reach the highest leadership positions in academic plastic surgery. Contributing factors include lack of female role models/mentors and lack of gender diversity. Studies show that female role models and mentors are critical for recruiting and retaining female surgeons and that gender diversity within organizations more strongly influences women's career choices. The authors therefore sought to determine the current gender diversity of academic plastic surgery programs and investigate influences of gender and leadership on program gender composition.

METHODS

A cross-sectional study of U.S. plastic surgery residency programs was performed in December of 2018. Genders of the leadership were collected, including medical school dean, department of surgery chair, department/division of plastic surgery chair/chief, plastic surgery program director, plastic surgery faculty, and plastic surgery residents. Gender relationships among these groups were analyzed.

RESULTS

Ninety-nine residency programs were identified (79 integrated with or without independent and 20 independent). Women represented a smaller proportion of academic plastic surgeons in more senior positions (38 percent residents, 20 percent faculty, 13 percent program directors, and 8 percent chairs). Plastic surgery chair gender was significantly correlated with program director gender, and plastic surgery faculty gender was significantly associated with plastic surgery resident gender. Although not statistically significant, female plastic surgery chair gender was associated with a 45 percent relative increase in female plastic surgery residents.

CONCLUSIONS

Women in leadership and gender diversity influence the composition of academic plastic surgery programs. Gender disparity exists at all levels, worsening up the academic ladder. Recruitment, retention, and promotion of women is critical, as such diversity is required for continued progress in innovation and problem-solving within plastic surgery.

Attracting the Best Students to a Surgical Career

The predicted shortage of surgeons in the future workforce is already occurring in rural areas and is expected to worsen. US allopathic medical school graduates have been losing interest in surgery for the past 40 years. The residency match remains unaffected because of foreign and osteopathic applicants. Negative myths regarding surgeon training, lifestyle, and personality persist among medical students, proving to be a powerful deterrent to students who might consider a surgical career. Proven strategies for making surgery more attractive to students are not always used and can be as simple as getting early exposure to students before clinical rotations.

Exploring the Impact of the Surgical Exploration and Discovery (SEAD) Program on Medical Students' Perceptions of Gender Biases in Surgery: A Mixed-Method Evaluation

OBJECTIVE

Female representation in surgery is increasing; however, many surgical specialties continue to observe disproportionately fewer females entering their residencies. This study assesses how medical students' gender-based perceptions of surgical careers are impacted by attending the Surgical Exploration and Discovery (SEAD) program, a 2-week, immersive procedural program that offers observerships, mentorship, and workshops across 8 surgical specialties.

DESIGN

In this mixed-method prospective cohort study, medical students' awareness, beliefs, and experiences of gender bias in surgery were assessed using a 10-item Gender Bias in Medical Students Assessment-Surgery (GBMSA-S) psychometric survey instrument inspired by the validated Gender Bias in Medical Education Scale (Parker et al., 2016).

SETTING

Undergraduate Medical Education, Faculty of Medicine, at the University of Ottawa in Ottawa, Ontario, Canada.

PARTICIPANTS

Eighteen first-year medical students in the experimental group (8 male, 10 female) and 18 in the control group (7 male, 11 female).

RESULTS

Compared to the control group, SEAD participants had significant changes in agreement with the statements: "surgery is male-dominated," "medical studies are mainly done in males," "gender discrimination is more pronounced in surgery than other medical professions," "consideration of my gender is an important factor in whether or not to pursue surgery as a career," and "I have encountered gender-biased attitudes and/or behaviors among non-physician health care staff" (p < 0.05). Perceptions of gender bias were reduced post-SEAD. Subgroup analysis by gender suggested that the significance of these changing perspectives was due to female participants' responses. SEAD also produced an increase in the level of interest in surgery (p = 0.04). Receptive and authentic dialogue was identified as a critical step toward social inclusivity (n = 11).

CONCLUSIONS

Early surgical exposure through SEAD produces a statistically significant increase in surgical interest and reduces certain perceptions of gender bias in surgery, particularly among female medical students.

Gender Disparity in Surgical Society Leadership and Annual Meeting Programs

INTRODUCTION

Prior work suggests women surgical role models attract more female medical students into surgical training. We investigate recent trends of women in surgical society leadership and national conference moderator and plenary speaker roles.

METHODS

Gender distribution was surveyed at 15 major surgical societies and 14 conferences from 2014 to 2018 using publicly reported data. Roles were categorized as leadership (executive council), moderator, or plenary speaker. Data were cross-checked from online profiles and by contacting societies. Logistic regression with Huber-White clustering by society was utilized to evaluate proportions of women in each role over time and determine associations between the proportion of women in executive leadership, and scientific session moderators and plenary speakers.

RESULTS

The proportion of leadership positions held by women increased slightly from 2014 to 2018 (20.6%-26.6%, P = 0.23), as did the proportion of moderators (26.2%-30.6%, P = 0.027) and plenary speakers (26.2%-30.9%, P = 0.058). The proportion of women in each role varied significantly across societies (all P < 0.001): leaders (range 0.0%-52.0%), moderators (12.5%-58.8%), and plenary speakers (11.3%-60.0%). Three patterns of change were observed: eight societies (53.3%) demonstrated increases in representation of women over time, four societies (26.6%) showed stable moderate-to-good gender balance, and three societies (20.0%) had consistent underrepresentation of women.

CONCLUSION

There is significant variability in the representation of women at the leadership level of national surgical societies and participating at national surgical conferences as moderators and plenary speakers. Over the past 5 years some societies have achieved advances in gender equity, but many societies still have substantial room for improvement.

Gender Disparities in Medical Student Surgical Skills Education

OBJECTIVE

Female medical students and surgical trainees are more likely to lack confidence in their clinical abilities than their male peers despite equal or superior performance. This study aims to examine the role of gender in medical student experience and confidence performing technical skills in surgical clerkship.

DESIGN

This was a single-center survey study conducted over 2 academic years (2016-2018). Students were surveyed on their experience and confidence performing a set of 9 technical skills during surgical clerkship and to identify skill-specific barriers to learning.

SETTING

This study was performed at Western University, London, Ontario, Canada.

PARTICIPANTS

All third-year medical students were invited to participate.

RESULTS

A total of 253 students participated yielding a survey response rate of 74.0%. Both male and female students reported similar levels of preclerkship interest in a surgical career, enjoyment in performing technical skills, confidence in ability to learn surgical skills and pursuit of available learning opportunities. At the conclusion of their surgical rotations, female students reported less experience and confidence performing technical skills compared to their male colleagues. Female students were more likely to cite an insufficient number of learning opportunities from consultant and resident teachers, time constraints, and lack of confidence as barriers to the achievement of technical proficiency.

CONCLUSIONS

Female gender was associated with less procedural experience and inferior confidence performing procedural skills. It is important for educators to be aware of this gender disparity and to actively promote equitable learning opportunities for female trainees.

Factors Influencing Female Medical Students' Decision to Pursue Surgical Specialties: A Systematic Review

INTRODUCTION

Gender inequality within the medical field continues to be a prominent issue, particularly for surgical specialties. The purpose of this systematic review was to evaluate the factors that influence female medical students' decision to pursue a career in surgery, including general surgery and surgical subspecialties.

METHODS

A literature search was conducted by 2 independent researchers searching PubMed, Embase, Medline, Web of Science, and Science Direct databases, in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Keywords included "female," "medical students," "surgery," "gender," "career," "surgical subspecialty," "plastic surgery," "otolaryngology," "neurosurgery," "orthopedics," and "urology." Studies evaluating factors that influenced female medical students' decision to pursuing surgical specialties were identified.

RESULTS

The initial search identified 2200 articles. Five hundred twenty-seven duplicates were removed, and 1993 studies were eliminated based on inclusion and exclusion criteria. Sixty-one articles underwent full-text review. Twenty-six additional studies were identified from references. A total of 14 articles were included in the review. Female medical students were positively influenced by mentorship, intellectual challenge, the rewarding nature of surgery, and specialty exposure. Gender discrimination, surgical lifestyle, and societal and cultural barriers were deterrents for female medical students. Compared to male, females minimized the importance of prestige and expected financial rewards.

CONCLUSIONS

This systematic review identifies mentorship, specialty exposure, nature of the surgical field, gender discrimination, and personal factors to be major determinants in female medical students' decisions to pursue a career in surgery. While factors such as inherent interest in surgery may not be easily modified, improvements in gender discrimination, access to mentorship, and specialty exposure can attract more female trainees to surgical specialties. Specifically, improving parental leave policies, reducing pregnancy-related stigma, eliminating gender-discrimination, matching medical students with role models early, and implementing outreach programs designed for women may increase students' interest in a surgical career.

Does Presence of role Models at Undergraduate Training Level Impact the Choice of Specialization as Maxillofacial Surgery for Young Women Dental Graduates?: Qualitative Study and Review Of Literature

INTRODUCTION

Even though dentistry is becoming a women-dominated profession, this is not translating into the choosing oral and maxillofacial surgery as a specialization. Hence, this study was undertaken to analyse factors impacting the choice of specialization and what impact does presence of role models as an intervention have on the attitudes of these young women on their overall career choice decisions.

PURPOSE

This qualitative study was undertaken with the aim of understanding and analyzing the impact of role models on the overall shift in attitude of young women graduate students towards oral and maxillofacial surgery as a specialty.

METHODS

Eleven women maxillofacial faculties from all over the country participated in this study conducted during the 2020 Pandemic. In this study, through the online teaching programme, the influence of women teaching faculties in the form of role models was statistically analysed on 103 attendees out of 140 who answered the survey questionnaire. The sessions were conducted on Zoom platform in the form of lectures of graduate course topics as defined by Dental Council of India. The overall attitudinal shift was then statistically analysed through Chi-square test.

RESULT

Out of 140 students, 103 students responded to the survey questionnaire. Responses of these students were statistically analysed with Chi-square test. The p value <.05 confirmed the hypothesis that presence of role models does have an impact on the choice of specialization.

CONCLUSION

The sample size of this was small and the period of follow-up was short, four months. In order to validate these results, larger cohort and longitudinal studies of long follow-up are needed. In spite of these drawbacks, the results of this study highlight, with the help of the literature, the important role a woman mentor positively plays in career choice and other aspects of women surgeon's professional life.

History of African women in neurosurgery

The number of women in the medical field has increased in Africa over the last few decades, yet the underrepresentation of women within neurosurgery has been a recurrent theme. Of all surgical disciplines, neurosurgery is among the least equitable, and the rate of increase in female surgeons lags behind other surgical disciplines such as general surgery. This historical review provides an overview of the history of women in neurosurgery and their current status on the African continent. To the authors' knowledge, this is the first article to provide such an overview.

A Survey of Perceptions of Surgical Trainees on Feedback During Training in West Africa

BACKGROUND

Feedback has become an integral part of learning within the medical profession, particularly as training becomes more trainees'-centered. Feedback from the trainees about their training and trainers is essential for effective and high-quality training. The purpose of this survey was to evaluate trainees' perceptions on feedback on their postgraduate training and trainers in West Africa.

METHODS

Cross-sectional self-administered written survey of junior and senior registrar attending the annual revision and update course of the West African College of Surgeons. Information sought included sociodemographic variables, perception on feedback, opportunity to give feedback, trainee-trainers relationship and their opinion on different aspects of the postgraduate program where they would like to give feedback.

RESULTS

The response rate was 81.5% (66/81). Median age was 33 years. Sixty trainees (90.9%) were junior registrars. Sixty-four (97%) trainees would like to give feedback about their training and trainers. Only 18 (27.3%) trainees have had opportunity of giving feedback about their training. Most trainees (90.9%) would like to give feedback on patient care and learning environment; 89.4% would like to give feedback on their training curriculum and 87.9% would like to give feedback on their operating room experiences. Most trainees (81.8%) believed trainee feedback is of critical importance to training. With regard to trainees-trainer relationship, 39 (59.1%) trainees were either unsatisfied or reported just a fair relationship.

CONCLUSIONS

This study has shown that many of the trainees lack opportunity of giving feedback on their training but considered feedback critical to their training. Trainees would like to give feedback on patient care, curriculum, learning environment and operative room experience. Trainee feedback should be encouraged in surgical training in West Africa.

Becoming a resident in a high demanded medical specialty: an unequal race? Evidence from the Spanish resident market

BACKGROUND

Gender occupational segregation in medicine is associated with several undesired consequences such as earnings disparity, shortages of specialists or lower quality of care among others. This paper focuses on the persistent gender gap observed in the most popular specialties of the Spanish resident market. In particular, it explores the role of the specialty allocation system in perpetuating the occupational segregation. For that purpose, this paper studies the effect of a policy change in the ranking system that determines doctors' specialty choice order. The change increased the competitiveness of the process by increasing the weight of an entry examination from 75% to 90%, in detriment of doctors' grade point average that decreased from 25% to 10%. Findings from previous literature suggest that that male and female doctors might have reacted differently to the increased competitiveness of the process.

METHODS

Data come from administrative records of doctors' specialty choices for the years 2013 and 2015 and they are used to compute the difference between doctors' pre and post-change ranking positions. Then, differences in the distribution of rank differences between male and female doctors are tested by means of parametric (T-test) and non-parametric (Wilcoxon rank) approaches.

RESULTS

Results show that the policy change has overall favoured male doctors. On average, female doctors lose ranking positions, with respect to the position they would have achieved with the old weights, whilst male doctors gain positions. The differences are more pronounced in the top half of the ranking distribution, meaning that female doctors on average have reduced their probability of accessing the most demanded specialties.

CONCLUSIONS

The objective of the policy was the enhancement of the prospects of Spanish-graduate doctors with respect to international graduates by giving more weight to the less prone to bias examination scores. Nonetheless, the change have had the unintended consequence of reducing the probability of female doctors accessing highly demanded specialties and thus exacerbating the gender gap. The allocation system needs revision to make it accountable for the actual role of doctors in society.

Women in thoracic surgery: social media and the value of mentorship

Social media serves as a tool to fill gaps in current efforts to promote women in cardiothoracic surgery, and, given its global reach, may be a particularly effective modality. Social media has an important role in networking and mentorship, especially for women seeking careers in specialties with relatively sparse female representation, such as cardiothoracic surgery. In addition, social media may facilitate professional interactions, collaboration, growth of online reputations, engagement in continued education, communication of novel research findings, and patient education. Herein, we review the evidence for social media in the networking and mentorship of women in cardiothoracic surgery. Future studies are needed to establish the durability of social media efforts and predictors in its effectiveness in achieving its goals.

Update on workforce diversity in vascular surgery

OBJECTIVE

Creating a diverse workforce is paramount to the success of the surgical field. A diverse workforce allows us to meet the health needs of an increasingly diverse population and to bring new ideas to spur technical innovation. The purpose of this study was to assess trends in workforce diversity within vascular surgery (VS) and general surgery (GS) as compared with orthopedic surgery (OS)-a specialty that instituted a formal diversity initiative over a decade ago.

METHODS

Data on the trainee pool for VS (fellowships and integrated residencies), GS, and OS were obtained from the U.S. Graduate Medical Education reports for 1999 through 2017. Medical student demographic data were obtained from the Association of American Medical Colleges U.S. medical school enrollment reports. The representation of surgical trainee populations (female, Hispanic, and black) was normalized by their representation in medical school. We also performed the χ² test to compare proportions of residents over dichotomized time periods (1999-2005 and 2013-2017) as well as a more sensitive trend of proportions test.

RESULTS

The proportion of female trainees increased significantly between the time periods for the three surgical disciplines examined (P < .001). Hispanic trainees also represented an increasing proportion of all three disciplines (P ≤ .001). The proportion of black trainees did not significantly change in any discipline between the two periods. Relative to their proportion in medical school, Hispanic trainees were well represented in all surgical specialties studied (normalized ratio [NR], 0.95-1.52: 0.95 OS, 1.00 GS, 1.53 VS fellowship, and 1.23 VS residency). Compared with their representation in medical school, women were under-represented as surgical trainees (NR: 0.32 OS, 0.82 GS, 0.56 VS fellowship, and 0.78 VS residency) as were black trainees (NR: 0.63 OS, 0.90 GS, 0.99 VS fellowship, and 0.81 VS residency).

CONCLUSIONS

Although there were significant increases in the number of women and Hispanic trainees in these three surgical disciplines, only Hispanic trainees enter the surgical field at a rate higher than their proportion in medical school. The lack of an increase in black trainees across all specialties was particularly discouraging. Women and black trainees were under-represented in all specialties as compared with their representation in medical school. The data presented suggest potential problems with recruitment at multiple levels of the pipeline. Particular attention should be paid to increasing the pool of minority medical school graduates who are both interested in and competitive for surgical specialties.

Barriers to Women Entering Surgical Careers: A Global Study into Medical Student Perceptions

BACKGROUND

Barriers to female surgeons entering the field are well documented in Australia, the USA and the UK, but how generalizable these problems are to other regions remains unknown.

METHODS

A cross-sectional survey was developed by the International Federation of Medical Students' Associations (IFMSA)'s Global Surgery Working Group assessing medical students' desire to pursue a surgical career at different stages of their medical degree. The questionnaire also included questions on students' perceptions of their education, resources and professional life. The survey was distributed via IFMSA mailing lists, conferences and social media. Univariate analysis was performed, and statistically significant exposures were added to a multivariate model. This model was then tested in male and female medical students, before a further subset analysis by country World Bank income strata.

RESULTS

639 medical students from 75 countries completed the survey. Mentorship [OR 3.42 (CI 2.29-5.12) p = 0.00], the acute element of the surgical specialties [OR 2.22 (CI 1.49-3.29) p = 0.00], academic competitiveness [OR 1.61 (CI 1.07-2.42) p = 0.02] and being from a high or upper-middle-income country (HIC and UMIC) [OR 1.56 (CI 1.021-2.369) p = 0.04] all increased likelihood to be considering a surgical career, whereas perceived access to postgraduate training [OR 0.63 (CI 0.417-0.943) p = 0.03], increased year of study [OR 0.68 (CI 0.57-0.81) p = 0.00] and perceived heavy workload [OR 0.47 (CI 0.31-0.73) p = 0.00] all decreased likelihood to consider a surgical career. Perceived quality of surgical teaching and quality of surgical services in country overall did not affect students' decision to pursue surgery. On subset analysis, perceived poor access to postgraduate training made women 60% less likely to consider a surgical career [OR 0.381 (CI 0.217-0.671) p = 0.00], whilst not showing an effect in the men [OR 1.13 (CI 0.61-2.12) p = 0.70. Concerns about high cost of training halve the likelihood of students from low and low-middle-income countries (LICs and LMICs) considering a surgical career [OR 0.45 (CI 0.25-0.82) p = 0.00] whilst not demonstrating a significant relationship in HIC or UMIC countries. Women from LICs and LMICs were 40% less likely to consider surgical careers than men, when controlling for other factors [OR 0.59 CI (0.342-1.01 p = 0.053].

CONCLUSION

Perceived poor access to postgraduate training and heavy workload dissuade students worldwide from considering surgical careers. Postgraduate training in particular appears to be most significant for women and cost of training an additional factor in both women and men from LMICs and LICs. Mentorship remains an important and modifiable factor in influencing student's decision to pursue surgery. Quality of surgical education showed no effect on student decision-making.

The experiences of female surgeons around the world: a scoping review

INTRODUCTION

The Lancet Commission for Global Surgery identified an adequate surgical workforce as one indicator of surgical care accessibility. Many countries where women in surgery are underrepresented struggle to meet the recommended 20 surgeons per 100,000 population. We evaluated female surgeons' experiences globally to identify strategies to increase surgical capacity through women.

METHODS

Three database searches identified original studies examining female surgeon experiences. Countries were grouped using the World Bank income level and Global Gender Gap Index (GGGI).

RESULTS

Of 12,914 studies meeting search criteria, 139 studies were included and examined populations from 26 countries. Of the accepted studies, 132 (95%) included populations from high-income countries (HICs) and 125 (90%) exclusively examined populations from the upper 50% of GGGI ranked countries. Country income and GGGI ranking did not independently predict gender equity in surgery. Female surgeons in low GGGI HIC (Japan) were limited by familial support, while those in low income, but high GGGI countries (Rwanda) were constrained by cultural attitudes about female education. Across all populations, lack of mentorship was seen as a career barrier. HIC studies demonstrate that establishing a critical mass of women in surgery encourages female students to enter surgery. In HICs, trainee abilities are reported as equal between genders. Yet, HIC women experience discrimination from male co-workers, strain from pregnancy and childcare commitments, and may suffer more negative health consequences. Female surgeon abilities were seen as inferior in lower income countries, but more child rearing support led to fewer women delaying childbearing during training compared to North Americans and Europeans.

CONCLUSION

The relationship between country income and GGGI is complex and neither independently predict gender equity. Cultural norms between geographic regions influence the variability of female surgeons' experiences. More research is needed in lower income and low GGGI ranked countries to understand female surgeons' experiences and promote gender equity in increasing the number of surgical providers.

Pregnancy and Parenthood Remain Challenging During Surgical Residency: A Systematic Review

PURPOSE

To examine common themes and synthesize data surrounding pregnancy and parenthood during surgical residency training.

METHOD

The authors conducted a systematic search of the literature in March 2019. They searched MEDLINE, EMBASE, and Scopus, seeking articles published from 2003 to 2018 that focused on pregnancy, parenthood, and the experience of surgical residents. They excluded articles that examined nonsurgical programs, as well as editorials, abstracts, and commentaries. Two investigators independently reviewed all citations, selected articles for full-text review, and extracted data from the selected articles.

RESULTS

Of 523 titles and abstracts screened, 27 were included. Overall, female surgical residents had fewer children during residency training than their male counterparts (18%-28% vs 32%-54%). As compared with the general population, surgical residents had their first child later in life (30-34 vs 25 years old), and had fewer children overall (0.6-2.1 vs 2.7). Infertility rates were higher among female surgeons than in the general population (30%-32% vs 11%), as were assisted reproductive technology rates (8%-13% vs 1.7%). Pregnant surgical residents experienced a high rate of obstetrical complications; working more than 6 overnight calls shifts per month or 60 hours per week were predictors of increased complication rates. The authors noted no differences in attrition, caseload, or exam pass rates amongst female surgical residents who had become pregnant as compared with other residents. Despite these similar academic outcomes, negative attitudes and perceptions toward pregnancy during residency were consistently identified.

CONCLUSIONS

Female surgical residents experience high rates of infertility and obstetrical complications, contend with negative attitudes and stigma during their pregnancies, and voluntarily delay childbearing. Formal maternity policies, a shift in surgical culture, and ongoing discussion with all stakeholders are needed to attract and retain female surgical residents.

The future of general surgery in Ireland: factors influencing career decisions of medical students

INTRODUCTION

The decline in popularity of general surgery as a career has been well described. A number of factors have been put forward to explain this, for example, trainee burnout and perceived difficulty with work/life balance. The aim of this study was to elucidate the reasons for this among medical students in Ireland.

METHOD

A questionnaire was distributed to clinical year medical students in Ireland using an online survey via SurveyMonkey™. Domains assessed included demographics, career plan and associated rationale. Anonymised responses were collated and evaluated.

RESULTS

There were 307 responses (response 23%). Females accounted for 66% (202). Mean age was 24 years (SD = 2.89). One hundred twelve responses (36%) were contemplating becoming surgeons. One hundred nine-five responses were not considering surgery: however 87 had previously considered. Of the 87, 41 (47%) attributed the decision to work/life balance, 30 (35%) to impact on personal relationships and 10 (11%) blamed unclear career projection. Students interested in surgery were asked to quantify their knowledge of the application process-17 (15%) good, 39 (35%) fair and 56 (50%) poor.

CONCLUSION

A small proportion of respondents plan to pursue a career in general surgery. This is concerning in view of attrition rates through junior years. Although lifestyle factors are significant, clarity regarding training pathways was also reported. Undergraduate education regarding career trajectory, quality of life and practicalities of a career in general surgery may increase applications.

The role of the University of Cape Town, South Africa in the training and retention of surgeons in Sub-Saharan Africa

BACKGROUND

Sub-Saharan Africa (SSA) has a shortage of surgeon specialists. Many SSA countries lack specialty training programs but South Africa, an upper middle-income country, has several post-graduate surgical training programs. The primary objective of this study was to describe the retention rates of non-South African SSA surgical trainees from the University of Cape Town (UCT) on the African sub-continent. The secondary objective was to describe advantages and disadvantages of foreign surgical trainees on the UCT surgical training programs.

METHODS

This was a two-part cross-sectional survey administered via email between June 1, 2018 and March 1, 2019 to UCT 1) surgical residents and fellows who graduated between 2007 and 2017 and whose country of origin was in SSA but outside South Africa, and 2) UCT surgical division heads.

RESULTS

Thirty out of 78 (38%) trainees responded; 83% (n = 25) were male. There was a 96% retention rate of surgical trainees in SSA, 80% (n = 24) returned to their country of origin after training, 83% (n = 25) worked in the public sector, and 90% (n = 27) in teaching hospitals. Seven out of ten surgical division heads responded. Reported advantages of SSA trainees included more junior staff (n = 5, 71%) and the establishment of SSA networks (n = 4, 57%). Disadvantages included increased training responsibilities for educators (n = 2, 29%) and fewer cases for South African trainees (n = 2, 29%).

DISCUSSION

Retention on the African sub-continent of surgeons who trained at UCT was high. SSA doctors can utilize South African post-graduate surgical training programs until their own countries increase their training capacity. The majority of trainees returned to their countries of origin, utilizing their skills in the public and academic sectors, and contributing to the teaching of more trainees. These training partnerships also contribute to knowledge-sharing and facilitate a regional network of African surgeons. Active recruitment of more female trainees is needed to ensure gender equity.

The role of gender in the decision to pursue a surgical career: A qualitative, interview-based study

BACKGROUND

Previous literature has explored the underrepresentation of women in surgery. However, this research has often been quantitative or limited by considering only the perspectives and experiences of women at more advanced career stages. Here, we use a qualitative methodology and a sample of women and men across the career continuum to identify the role that gender plays in the decision to pursue a surgical career.

METHODS

We audio-recorded and transcribed semi-structured interviews conducted with 12 women and 12 men ranging in their level of medical training from medical students to residents to staff surgeons. We used Braun and Clarke's six-step approach to thematic analysis to analyze the data, maintaining trustworthiness and credibility by employing strategies including reflexivity and participant input.

RESULTS

Our findings suggested that the characteristics of surgery and early exposure to the profession served as important factors in participants' decisions to pursue a surgical career. Although not explicitly mentioned by participants, each of these areas may implicitly be gendered. Gender-based factors explicitly mentioned by participants included the surgical lifestyle and experiences with gender discrimination, including sexual harassment. These factors were perceived as challenges that disproportionately affected women and needed to be overcome when pursuing a surgical career.

CONCLUSIONS

Our findings suggest that gender is more likely to act as a barrier to a career in surgery than as a motivator, especially among women. This suggests a need for early experiences in the operating room and mentorship. Policy change promoting work-life integration and education to target gender discrimination is also recommended.

Demographics in general surgery programs: Relationship between female faculty and proportion of female residents

INTRODUCTION

We hypothesized that general surgery programs with more female faculty and leadership may be associated with more female residents.

METHODS

The Fellowship and Residency Electronic Interactive Database Access system (FREIDA) was assessed for chair gender, program director gender, percentage of female faculty, and percentage of female residents at general surgery residency programs. Programs were stratified by type: university-based (UB), community-based/university-affiliated (UA) and community-based (CB).

RESULTS

304 general surgery programs reported a mean of 38.4% female residents which did not differ by program type. Chairs were more likely female in UB programs (12.8%) versus 5.5% in UA and CB programs (p = 0.05). There were more female faculty at UB programs (23.3%) versus UA (21.7%) and CB (17.4%) (p = 0.04). Chair (p = 0.21), program director (p = 0.98) and faculty gender proportion (p = 0.40) was not associated with female resident complement.

CONCLUSIONS

In general surgery programs, faculty and leadership gender composition was not associated with proportion of female residents.

A Report on the Representation of Women in Academic Plastic Surgery Leadership

BACKGROUND

The year 2017 marked the first year women comprised a majority of U.S. medical school matriculants. While more women are pursuing surgical training, within plastic surgery, there is a steady attrition of women advancing in leadership roles. The authors report the current status of women in academic plastic surgery, from trainees to chairwomen and national leadership positions.

METHODS

The Electronic Residency Applications Service, San Francisco Match, National Resident Matching Program, Association of American Medical Colleges, American Council of Academic Plastic Surgeons, Plastic Surgery Education Network, and professional websites for journals and national societies were accessed for demographic information from 2007 to 2017.

RESULTS

The number of female integrated pathway applicants remained stable (30 percent), with an increased proportion of female residents from 30 percent to 40 percent. There was an increase in female faculty members from 14.6 percent to 22.0 percent, an increase of less than 1 percent per year. Twelve percent of program directors and 8.7 percent of department heads were women. Nationally, major professional societies and administrative boards demonstrated a proportion of female members ranging from 19 percent to 55 percent (average, 27.7 percent). The proportion of female committee leaders ranged from 0 percent to 50 percent (average, 21.5 percent). Only six societies have had female presidents. No major journal had had a female editor-in-chief. The proportion of female editorial board members ranged from 1 percent to 33 percent (average, 16.1 percent).

CONCLUSIONS

The authors' study shows a leak in the pipeline at all levels, from trainees to faculty to leadership on the national stage. This report serves as a starting point for investigating reasons for the underrepresentation of talented women in plastic surgery leadership.