The confidence gap: Findings for women in plastic surgery

Gender Gap? A Survey among Plastic Surgeons in Germany

INTRODUCTION

There is an ongoing increase in the percentage of females in the field of Plastic Surgery in Germany. Currently, 29,1% of fellows and 46% of residents in Germany are female. Several studies have pointed out the various obstacles that female doctors, especially female plastic surgeons, are confronted with in their professional life. The aim of this study is to examine gender parity among plastic surgeons in Germany. Furthermore, we aim to evaluate the opinion of both women and men on gender-specific discrimination.

METHODS

In a nonrandomized, cross-sectional study an anonymous questionnaire covering various subjects such as education/training, career path, the compatibility of family and career, as well as the subjective perception of gender equality in Plastic Surgery was distributed among members of the German Association of Plastic, Reconstructive and Aesthetic Surgery (DGPRÄC) as well as through social media. Data was collected with Google Docs.

RESULTS

The sample group (n = 285) composition was 162 female (56,8%), 122 (42,9%) male and 1 nonbinary (0,4%). The majority of women (54.3%) and men (49.1%) rated work-life balance as "difficult". In 82.1% of women and 44.3% of men, family planning was influenced by the profession. Most of the respondents work in hospitals (62.9% of women and 50.0% of men). The main motivation of 61.4% of women to go to in private practice was family reasons, 51.8% of men gave financial reasons. 64.1% of women and 54.1% of men have a doctoral degree, whereas 6.9% of women and 13.3% of the men have a postdoctoral degree. While 33.6% of the men believe that their own gender had no influence on their respective career decision, career progress or success, only 4.9% of women had the same opinion. In addition, 43.8% of women and 22.1% of men reported having experienced sexual harassment in their professional lives.

CONCLUSION

This study reveals significant gender differences in career development in Plastic Surgery. Family planning, motivations for establishment and academic careers, as well as the experience of sexual harassment, are of primary concern. Actively helping to shape the work environment of career development opportunities in light of this study may help to reduce gender disparities in Plastic Surgery in the future.

Evaluating the Paucity of Female Surgeons in Plastic Surgery: A Review of the Systemic Barriers to Entry and Success

The percentage of practicing female plastic surgeons in the United States is notably low. This narrative review sought to identify prominent barriers affecting women's entry and success in plastic surgery. A literature search was conducted using the National Library of Medicine from 2013 to 2023, using MeSH terms of gender disparity and plastic surgery. Included publications were peer-reviewed articles and systematic reviews evaluating gender disparity in plastic surgery, examining experiences, challenges, or opportunities for female plastic surgeons. Excluded publications did not include data gathered from the United States, included other minorities, or did not focus on plastic surgery. Overall, 191 papers were identified, with 14 papers being selected for this review. Early barriers identified before residency training include the lack of female mentors and the underrepresentation of female presenters at national plastic surgery conferences, with females comprising only 29% of presenters and 16% of abstract senior authors at national plastic surgery conferences between 2014 and 2015. During residency training, the most prominent barrier is pregnancy, with 73% of women delaying childbearing during residency and only 39% of men reporting the same. A second barrier during training includes gender disparity in the number of research publications, with females publishing 8.89 ± 0.97 publications during residency and males publishing 12.46 ± 1.08 publications (p = 0.0394). After residency training, evidence of barriers to career advancement includes poor representation of women in higher academic positions, such as program chairs and directors, with female representation of 9.2% and 13.1%, respectively, and gender disparity in industry payments. Systemic barriers before, during, and after plastic surgery residency training seem to influence the representation of women in plastic surgery at all levels. These barriers should be addressed to increase the number of practicing female plastic surgeons and diversify the field.

Gender-Based Differences in Medical Student Self-Ratings of Clinical Performance

INTRODUCTION

While prior literature demonstrates gender-based differences in surgical residents' self-assessments, limited data exist examining these effects at the medical student level. This study aimed to understand how self-ratings of clinical performance differ across genders for clerkship students.

METHODS

This was a retrospective study examining the results of an institutional Clinical Performance Examination administered at the end of the clerkship year. Students were tasked with obtaining a history and physical examination and developing an assessment and plan based on standardized patient cases. After the examination, students were asked to estimate the percentile rating of their performance. Female and male students' true scores, self-rated percentiles, and differences between true and self-rated percentiles were compared.

RESULTS

One hundred twenty three male and 113 female medical students were included in the analysis. Female medical students performed statistically significantly better overall (79.65% versus 78.23%, P = 0.0039), in history skills (76.90% versus 75.19%, P = 0.012), and in communication skills (94.05% versus 92.58%, P = 0.0085). No statistically significant differences were seen between self-rated percentiles between male and female students. However, when comparing the difference between self-rated and true percentile scores (Δ = self-rated - true percentile), male students were more likely to rate themselves higher than their true percentile on history (male students Δ = 12.26 versus female students Δ = -1.24, P = 0.00076) and communication metrics (male students Δ = 14.12 versus female students Δ = 6.05, P = 0.037).

CONCLUSIONS

Despite higher performance, female students rate themselves similarly to male medical students, suggesting a pattern of underestimation. Faculty must recognize that gender-based differences in self-evaluations begin at the medical student level, potentially impacting future trainee development.

Evaluation of Surgical Requirements and Competencies of the Saudi Ophthalmology Training Program in a Tertiary Eye Specialist Hospital- A Cross-Sectional Study

Purpose

To evaluate the adequacy of a Saudi ophthalmology training programs in achieving the competencies outlined by the Saudi Commission for Health Specialties (SCFHS) and the Accreditation Council for Graduate Medical Education (ACGME) and to assess resident satisfaction with their training.

Methods

A cross-sectional survey was sent electronically to all trainees (n=50) enrolled in the King Khaled Eye Specialist Hospital (KKESH) ophthalmology training program by email and messaging app (Whatsapp). The survey was sent between January 20, 2021, and January 30, 2021. It evaluated the level of satisfaction with surgical training and skills. The surgical logbooks of all trainees were extracted, and identifiers were removed. Then they were compared with SCFHS and ACGME curriculums for ophthalmology training.

Results

Out of 50 invitees, 47 returned the questionnaire. All trainees were confident they could meet surgical requirements by the end of their training. Most trainees were satisfied (n=29, 61.7%) with their performance in core competency requirements. There was no difference between female and male trainees' comfort levels when performing surgical steps in core competency requirements (P=0.2). Senior trainees seem more satisfied with their performance, especially in core competency requirements (P=0.087). All trainees practice at the wet lab and a virtual reality simulator to improve their skills. Obstacles faced during training were highlighted, including low exposure in the operating theater (n=18, 37.50%), competition on cases (n=5, 10.42%), attending surgeons not willing to teach (n=5, 10.42%), COVID-19 pandemic (n=5, 10.42%), and complex cases (n=4, 8.33%).

Conclusion

The outcomes of the current study indicate that trainees at KKESH were adequately satisfied with their surgical training in general. Also, competencies outlined by both the SCFHS and the ACGME were adequately fulfilled.

Gender Differences in Perceived Working Conditions of General Practitioners During the COVID-19 Pandemic-a Cross-Sectional Study

BACKGROUND

The ongoing COVID-19 pandemic has revealed gender-specific differences between general practitioners in adapting to the posed challenges. As primary care workforce is becoming increasingly female, in many countries, it is essential to take a closer look at gender-specific influences when the global health care system is confronted with a crisis.

OBJECTIVE

To explore gender-specific differences in the perceived working conditions and gender-specific differences in challenges facing GPs at the beginning of the COVID-19 pandemic in 2020.

DESIGN

Online survey in seven countries.

PARTICIPANTS

2,602 GPs from seven countries (Austria, Australia, Switzerland, Germany, Hungary, Italy, Slovenia). Of the respondents, 44.4% (n = 1,155) were women.

MAIN MEASURES

Online survey. We focused on gender-specific differences in general practitioners' perceptions of working conditions at the beginning of the COVID-19 pandemic in 2020.

KEY RESULTS

Female GPs rated their skills and self-confidence significantly lower than male GPs (f: 7.1, 95%CI: 6.9-7.3 vs. m: 7.6, 95%CI 7.4-7.8; p < .001), and their perceived risk (concerned about becoming infected or infecting others) higher than men (f: 5.7, 95%CI: 5.4-6.0 vs. m: 5.1, 95%CI: 4.8-5.5; p = .011). Among female GPs, low self-confidence in the treatment of COVID-19 patients appear to be common. Results were similar in all of the participating countries.

CONCLUSIONS

Female and male GPs differed in terms of their self-confidence when dealing with COVID-19-related issues and their perceptions of the risks arising from the pandemic. To ensure optimal medical care, it is important that GPs realistically assess their own abilities and overall risk.

Who Cares about Diversity? Trends in Gender and Racial Authorship and Publications in Plastic Surgery over Time

The literature in scientific journals represents current standards for plastic surgery (PS) and new observations contributed by leaders in the field. Observations of these trends over time define our progress and document our ever-changing specialty. This study aims to assess the racial/ethnic and gender makeup of authors who have published on the topic of diversity in PS, and to define trends over time, as well as geographic and journal representation of these publications.

Experiences of Canadian Female Orthopaedic Surgeons in the Workplace: Defining the Barriers to Gender Equity

BACKGROUND

Only 13.6% of orthopaedic surgeons in Canada are women, even though there is nothing inherent to the practice of orthopaedic surgery that favors men over women. Clearly, there is a need to identify, define, and measure the barriers faced by women in orthopaedic surgery.

METHODS

An electronic survey was distributed to 330 female-identifying Canadian orthopaedic surgeons and trainees and included the validated Gender Bias Scale (GBS) and questions about career burnout. The barriers for women in Canadian orthopaedics were identified using the GBS. The relationships between the GBS and burnout were investigated. Open-text questions explored the barriers perceived by female orthopaedic surgeons.

RESULTS

The survey was completed by 220 female orthopaedic surgeons and trainees (66.7%). Five barriers to gender equity were identified from the GBS: Constrained Communication, Unequal Standards, Male Culture, Lack of Mentoring, and Workplace Harassment. Career burnout correlated with the GBS domains of Male Privilege (r = 0.215; p < 0.01), Disproportionate Constraints (r = 0.152; p < 0.05), and Devaluation (r = 0.166; p < 0.05). Five main themes emerged from the open-text responses, of which 4 linked closely to the barriers identified in the GBS. Work-life integration was also identified qualitatively as a theme, most notably the difficulty of balancing disproportionate parental and childcare responsibilities alongside career aspirations.

CONCLUSIONS

In this study, 5 barriers to workplace equity for Canadian female orthopaedic surgeons were identified using the validated GBS and substantiated with qualitative assessment using a mixed-methods approach. Awareness of these barriers is a necessary step toward dismantling them and changing the prevailing culture to be fair and equitable for all.

CLINICAL RELEVANCE

A just and equitable orthopaedic profession is imperative to have healthy and thriving surgeons who are able to provide optimal patient care.

The Importance of Mentorship in Shaping the Careers of Academic Leaders in Plastic Surgery

BACKGROUND

The majority of successful academic physicians cite mentorship as a critical element of their achievements. The goal of this study was to survey established leaders in plastic surgery to identify the importance that mentorship played in their career development, and to identify common themes that enabled them to "pay it forward" in helping to develop the next generation of leaders in plastic surgery.

METHODS

The authors performed a qualitative survey of 14 established leaders in plastic surgery (mentors) in the United States with a strong reputation for mentorship. The authors asked each to identify a key mentor (senior mentor) and mentee, grouping them in triads of a senior mentor, mentor, and mentee. The authors then submitted a similar survey to the mentee.

RESULTS

Thirteen mentor-mentee pairs for which both members had responded were included. After reviewing responses to these questions, the authors elicited a number of recurring themes. All respondents emphasized the importance of mentorship to their success in academic plastic surgery. Additional themes included encouraging mentees to find their passion, leading by example, discussing complex cases with residents/students, and using research time as an opportunity.

CONCLUSIONS

Strong patterns of mentorship are highlighted among the careers of leaders in academic plastic surgery. The authors advocate for formation of mentorship relationships within training programs and more national mentorship programs such as those emerging through the American Society of Plastic Surgeons and the Plastic Surgery Research Council for interested medical students, residents, and junior faculty.

Impact of Gender in Congenital Heart Surgery – Results from a National Survey

OBJECTIVE

There are limited data regarding the impact of gender within congenital heart surgery. Our aim was to assess gender-related experiences by surgeons in this field.

METHODS

A cross-sectional survey was emailed to practicing congenital heart surgeons to ascertain the perception of gender in 5 domains: training, professional career, clinical practice, personal life, and career outlook.

RESULTS

The survey response rate was 94% (17/18) for women and 44% (112/257) for men. More than half of women (53%) were discouraged from pursuing congenital heart surgery (P < .001) and reported a negative impact of gender in attaining their first congenital heart surgery job (P < .001) compared with men. Despite similar demographics, women reported lower starting annual salaries ($150K-$250K vs $250K-$400K), lower current annual salaries ($500K-$750K vs $750K-$1M), lower academic ranks (clinical instructor 6% vs 4% [P = .045], assistant professor 35% vs 19% [P = .19], associate professor 41% vs 25% [P = .24], and professor 6% vs 41% [P = .005]) along with lower annual salaries at the associate professor ($500K-$750K vs $1M-$1.25M) and professor levels ($1M-$1.25M vs >$1.5M) compared with men. Sexual harassment was experienced more frequently by women both in training (65% vs 6%, P < .001) and in practice (65% and 4%, P < .001).

CONCLUSIONS

This survey highlights many areas of gender-related differences: discouragement due to gender to pursue congenital heart surgery, sexual harassment in training and practice, salary and academic rank differentials, negative gender perception at work, and lower career satisfaction for women. Despite various differences between both genders, the majority in each group would choose to enter this profession again as well as encourage others to do so.

Identifying US Plastic Surgery Training Programs that Effectively Establish Gender and Ethnically Diverse Faculty

Background:

Successful strategies to improve the representation of female and ethnically underrepresented in medicine (UIM) physicians among US plastic and reconstructive surgery (PRS) faculty have not been adequately explored. Accordingly, we aimed to identify programs that have had success, and in parallel gather PRS program directors’ and chiefs/chairs’ perspectives on diversity recruitment intentionality and strategies.

Methods:

We conducted a cross-sectional analysis of the demographic composition of female and UIM faculty of PRS residency training programs. Separate lists of programs in the top quartile for female and UIM faculty representation were collated. Additionally, a 14-question survey was administered to program directors and chiefs/chairs of all 99 Accreditation Council for Graduate Medical Education-accredited PRS residency programs. The questions comprised three domains: (1) demographic information; (2) perceptions about diversity; and (3) recruitment strategies utilized to diversify faculty.

Results:

Female and UIM faculty representation ranged from 0% to 63% and 0% to 50%, respectively. Survey responses were received from program directors and chiefs/chairs of 55 institutions (55% response rate). Twenty-five (43%) respondents felt their program was diverse. Fifty-one (80%) respondents felt diversity was important to the composition of PRS faculty. Active recruitment of diverse faculty and the implementation of a diversity, equity, and inclusion committee were among the most frequently cited strategies to establish a culturally sensitive and inclusive environment.

Conclusions:

These findings reveal that female and UIM representation among US PRS faculty remains insufficient; however, some programs have had success through deliberate and intentional implementation of diversity, equity, and inclusion strategies.

From Self-efficacy to Imposter Syndrome: The Intrapersonal Traits of Surgeons

BACKGROUND

Demographic differences among surgical trainees regarding intrapersonal traits, such as imposter syndrome and assertiveness, have become widely acknowledged. However, many of these characteristics have not been examined in tandem, nor among both trainees and surgeons in practice. This study aimed to address these knowledge gaps.

METHODS

This was an anonymous, voluntary survey study comprised of validated measures of (1) self-efficacy, (2) imposter syndrome, (3) assertiveness, (4) perfectionism, and (5) self-rated likeability. A multimodal recruitment strategy was used and surgeons across all subspecialties were eligible for inclusion.

RESULTS

A total of 296 participants were included, with 54% identifying as female (n = 161) and 72% between the ages of 25 and 40 years of age (n = 212). Imposter syndrome, assertiveness, and perfectionism scales were normally distributed; self-efficacy and self-rated likeability scales demonstrated slight negative skew. Self-identified male sex was associated with less imposter syndrome (P < 0.001) and perfectionism (P = 0.035) and higher assertiveness (P < 0.001). Imposter syndrome was less common among older age groups (P = 0.001).

CONCLUSIONS

Surgeons are a self-efficacious group of perfectionists with widespread variability in imposter syndrome and assertiveness. Female sex and younger age were associated with more imposter syndrome and less assertiveness, highlighting an opportunity for early career coaching.

Closing the gap: Increasing female representation in surgical leadership

BACKGROUND

Female medical students outnumber males with increasing representation in the workforce. However, women remain underrepresented in surgical leadership. Suggested reasons for this discrepancy are lack of female role models, mentorship, and gender discrimination. Thus, we set out to examine the change in leadership over time in our Department.

METHODS

Leadership data was gathered from a Department of Surgery in 2016 and 2020. Demographics including gender, age, and leadership position were compared using chi-squared testing.

RESULTS

Female representation in leadership roles increased from 2016 to 2020 at each professor rank(professor 0-100%, p < .001; associate professor 25-90%, p < .001, and assistant professor 7-71%, p < .001). In 2020, there were more female faculty(19.8 vs 26.4%, p = .270).

CONCLUSIONS

Female leadership in the Department has increased since 2016. Promoting females to leadership roles provides role models for upcoming female surgeons. Resources should be allocated to promote gender equity in surgical leadership.