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

Advancing Inclusive Excellence in Pediatric Surgery: A National Longitudinal Mentorship Program

PURPOSE

The Alliance of Pediatric Surgeons Growing and Advancing Representation (APGAR) was created to systematically expand mentorship and sponsorship for learners historically underrepresented in pediatric surgery. We implemented a structured, multi-tiered mentorship model that includes participants from high school through attending pediatric surgeons. We report the conceptual framework, development, and implementation of APGAR's pilot programming, participants' perspectives, and short-term impact.

METHODS

Longitudinal mentorship groups ("pods") were established with representatives across training levels from high school students to pediatric surgery attendings. Pods met independently at least every 3 months, supplemented by APGAR-wide virtual programming on key topics,. To evaluate program impact, a survey was administered before pod formation (Apr/May 2022) and at the one-year follow-up (Apr/May 2023). Descriptive statistics were used to characterize participant demographics. Two-sample t-tests and chi-squared tests were used to compare survey variables.

RESULTS

Within 17 pods, 104 trainees and 26 faculty pediatric surgeons participated, representing 54 institutions. Ninety-five participants completed the pre-survey and 31 completed post-surveys (22 completed both). Survey participants (70% students) were primarily women (80%), 39% White, 26% Asian, 18% Black, 10% multiracial, and 6% Hispanic. After one year, APGAR significantly impacted respondents' appreciation of the intellectual challenge offered by a career in pediatric surgery (78% vs. 94%, p = 0.031). Most reported an interest in pursuing pediatric surgery (56%) and value the mentorship provided (77%).

CONCLUSION

APGAR programming successfully engaged learners in pediatric surgery through structured virtual programming, fostering early interest and exploration. Participants frequently cited the value of mentorship in shaping their perspectives.

LEVEL OF EVIDENCE

IV.

Beyond Mentorship: Walking the Talk Through Sponsorship to Support Women in Academic Surgery

Sponsorship is gaining recognition in academic surgery as an essential advancement beyond mentorship, particularly for women. While mentorship focuses on building the relationship between mentor and mentee to provide guidance, advice, and coaching, sponsorship entails more active involvement and buy-in from the senior towards the performance and growth of the junior. The ABCDs of sponsorship - Amplifying, Boosting, Connecting, and Defending - are powerful, concrete actions that can make a significant impact in the career and life of a future physician. However, throughout most of modern medicine, women have had to be pioneers without more senior women to follow as an example. Hence, building a culture of shared responsibility across all genders to mentor and sponsor women is essential to ensuring equitable access to opportunities.

Gender Representation Among Ophthalmology Fellowship Directors in 2022

PURPOSE

Women are underrepresented in several medical specialties, including ophthalmology. Reducing disparities is critical in diversifying perspectives and increasing equity within ophthalmology, both of which can ultimately improve care delivery. We examined ophthalmic fellowship programs directors in the United States to investigate gender disparities by subspecialty.

DESIGN

Cross-sectional study.

METHODS

This was a retrospective cross-sectional study of ophthalmology fellowship program directors in academic medical centers. The primary outcome measure was a descriptive analysis of current fellowship directors in 2022 when stratified by subspecialty and demographic features.

RESULTS

Analysis was conducted on 358 fellowship directors in the United States. Twenty-nine percent of directors were women. Female directors had significantly fewer years since residency graduation compared with male peers (17 vs 24; P < .001); however, no differences were observed by program type (P = .896) or location (P = 0.104). Differences in female director representation were observed by subspecialty (P < .001), with the greatest percentage of women in pediatric ophthalmology (54%), other (oncology and pathology) fellowships (50%), and medical retina (40%). The subspecialties with the lowest percentage of female directors were oculoplastic and reconstructive surgery (13%) surgical retina and vitreous (16%).

CONCLUSION

There are disparities in female representation in academic leadership positions across ophthalmic subspecialties. Addressing this difference may have critical impacts on career advancement and opportunities available for marginalized groups in medicine.

The Paradoxical Criticism of Gender Parity in Surgery

The present work explores a controversy surrounding gender equity in surgical residency programs, particularly focusing on the Stanford University and University of Washington (UW) General Surgery Residency cohorts. While the Stanford cohort, which consisted mostly of women, faced criticism from nonmedical audiences claiming that gender was prioritized over qualifications, the all-male radiology residents received less attention and fewer criticisms. The article highlights the double standards and challenges the notion of meritocracy. It discusses the gender and racial disparities in surgical residency programs, emphasizing the need for diversity and inclusion. The presence of diverse female representation is seen as a valuable asset that brings compassion, teamwork, and inclusive leadership to the field. The article calls for active support from institutions, male allies, and transparency in collecting applicant demographic data to address biases and promote gender diversity in surgery.

Beyond Parity: Gender Diversity of National and International Pediatric Surgery Societal Leadership

PURPOSE

Despite trends toward equal gender representation among medical school graduates, surgical trainees and fellows, diversity in higher levels of pediatric surgery is largely unstudied. This study aims to quantify gender diversity among leadership of pediatric surgical associations and societies across the globe.

METHODS

National and international pediatric surgical organizations were identified from the websites of the American Pediatric Surgical Association (APSA) and World Federation of Associations of Pediatric Surgery (WOFAPS). Compositional gender data of current and past organizational leadership was collected by examining publicly available archives of executive membership rosters. If roster pictures were not available, member names were input into social media sites and other search engines to ensure accurate gender denotation. Univariate analyses of organizational metrics and aggregate data of 5-year time intervals were performed via Fischer's Exact Test with significance of p < 0.05.

RESULTS

Nineteen pediatric surgical organizations were included for study analysis. Of 189 current organizational leaders, 50 (26.4%) are women. Eight organizations (42.1%) have less than 20% of leadership positions filled by women members, while two executive boards have no women members. Four organizations (22.2%) have a current woman seated as president/chairperson. Historical gender distribution stratified by organization demonstrates a range of 0-7.8% (p = 0.99), with one organization having yet to elect a woman president/chairperson. Longitudinally, women presidential representation remained consistently low (5-11%) across all time intervals from 1993 to 2022 (p = 0.35).

CONCLUSIONS

Despite advances in diversity in medical school graduates, surgical training, and workforce recruitment, there are still significant disparities in gender representation within pediatric surgery societal leadership.

LEVEL OF EVIDENCE

IV.

Initiation of the Virtual Interview: A 5-Y Evaluation of General Surgery Residency Match Results

INTRODUCTION

The virtual residency application season posed numerous challenges for the 2021 residency match process. Many residency programs are exploring relationships between this novel format and the match process. The purpose of this study was to compare one of the largest general surgery residency program's applications and match data from preCOVID years to the 2021 virtual cycle.

MATERIALS AND METHODS

A retrospective review was performed of applicants to a single general surgery residency program from 2017 to 2021. The primary outcome was the number of locally matched applicants. The secondary outcomes were the total number of applications, change in applicant demographics, and variability of the geographic spread during this study period. Chi-square tests of independence, Fisher's exact tests, and negative binomial regression were performed.

RESULTS

6819 applicants were included in the study. In 2021, an increase in applications was observed. The distribution of 2021 applications was statistically different from previous years regarding gender and race (P < 0.0001). The 2021 application cycle had a greater proportion of applicants from the United States (P < 0.0001) and southern US medical schools (P = 0.008). While the 2021 cycle had significantly more interviews (P = 0.013), there were no significant differences in the demographic composition of interviewees. During the 2021 application year, all 11 matches were from southern medical schools and there was a trend to more matched female applicants compared to previous years.

CONCLUSIONS

During the 2021 COVID-19 virtual match cycle, an increase in both the number of applications and number of interviews for general surgery residency was identified. The characteristics of applicants who interviewed and matched were not different when compared to previous years. As virtual interviews may become more commonplace, it is important to assess all factors that may be involved in the dynamic residency application process.

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.

Discrimination Toward Women in Surgery: A Systematic Scoping Review

BACKGROUND

Over the past twenty years explicit gender bias toward women in surgery has been replaced by more subtle barriers, which represent indirect forms of discrimination and prevents equality.

OBJECTIVE

The aim of our scoping review is to summarize the different forms of discrimination toward women in surgery.

METHODS

The database search consisted of original studies regarding discrimination toward female surgeons.

RESULTS

Of 3615 studies meeting research criteria, 63 were included. Of these articles, 11 (18%) were focused on gender-based discrimination, 14 (22%) on discrimination in authorship, research productivity, and research funding, 21 (33%) on discrimination in academic surgery, 7 (11%) on discrimination in surgical leadership positions and 10 (16%) on discrimination during conferences and in surgical societies. The majority (n = 53, 84%) of the included studies were conducted in the U.S.A. According to our analysis, female surgeons experience discrimination from male colleagues, healthcare workers, but also from patients and trainees. Possible solutions may include acknowledgment of the problem, increased education of diversity and integration for the younger generations, mentorship, coaching, and more active engagement by male and female partners to support women in the surgical field.

CONCLUSIONS

Gender-based discrimination toward women in the field of surgery has evolved over the past twenty years, from an explicit to a more subtle attitude. A work-environment where diversity and flexibility are valued would allow female surgeons to better realize their full potential.