Gender and Cardiothoracic Surgery Training: Specialty Interests, Satisfaction, and Career Pathways

Neurointervention-from entry to expertise: Examining gender bias across different training access routes in Europe

Background/purposeGender bias in academic medicine has been widely described. In Europe, training and career pathways in neurointervention (NI) are heterogeneous. We hypothesize that the access route to neuroradiology specialty and NI subspecialty may correlate with the proportion of women in the field and with their career progression.MethodsAn online survey consisting of 18 questions was distributed through European professional societies and several online social platforms. A total of 422 responses from 54 different countries were collected and statistically evaluated.ResultsAccess routes to specialty and subspecialty did not correlate with the number of women practicing NI. However, men were significantly more likely to have children, to occupy leading positions, to have more clinical experience and higher weekly workload both in diagnostic and interventional neuroradiology. Female gender significantly affected career progression.ConclusionThis study reflects a positive change in European reality concerning gender bias. Distinct training access routes do not seem to affect the proportion of female neurointerventionalists. However, gender differences still negatively impact women NI careers, leading to lower workload, having less children, and a limited access to leading positions in NI.

Risk Factors for Major Pregnancy Complications in Female Cardiothoracic Surgeons

OBJECTIVE

To describe the incidence of and risk factors for pregnancy complications in female cardiothoracic surgeons compared with women of similar sociodemographic profiles.

BACKGROUND

Female cardiothoracic surgeons often postpone childbearing, but little is known about their pregnancy outcomes.

METHODS

In 2023, a self-administered survey was distributed to US cardiothoracic surgeons/trainees. Surgeons with ≥1 live birth were queried on maternal work hours during pregnancy and major antenatal pregnancy complications. Male surgeons answered on behalf of non-surgeon childbearing partners (female non-surgeons).

RESULTS

The study included 255 surgeons (63.53% male; 36.47% female). Compared with female surgeons, male surgeons more often had partners who were not employed outside the home (25.64% vs 13.33%, P <0.001). Female surgeons were older than female non-surgeons at first live birth (34.49±4.41 vs 31.45±4.16, P <0.001), more often worked >60 h/wk during pregnancy (70.33% vs 14.08%, P <0.001), and more often had pregnancy complications (45.16% vs 27.16%, P =0.003; operating room (OR): 1.78, 95% CI: 1.01-3.13). Among female surgeons, 18.28% reduced work hours during pregnancy. During their third trimester, 54.84% worked >6 overnight calls/mo, and 72.04% operated >12 h/wk. Age ≥35 years (OR: 3.28, 95% CI: 1.27-8.45) and operating >12 h/wk during the third trimester (OR: 3.72, 95% CI: 1.04-13.30) were associated with pregnancy complications.

CONCLUSIONS

Female cardiothoracic surgeons are more likely to experience major pregnancy complications than non-surgeon partners of their male peers. Long operative hours during pregnancy and older maternal age are significant risk factors for pregnancy complications. To advance gender equity, policies to protect maternal-fetal health and facilitate childbearing during training and early career are needed.

Attitudes toward and exposure to gender discrimination in work life by pulmonologists and thoracic surgeons: a questionnaire-based survey among Turkish thoracic society members

Background

This study aimed to evaluate attitudes toward and exposure to gender discrimination in work life by chest diseases specialists and thoracic surgeons.

Methods

A total of 275 members of Turkish Thoracic Society (TTS) were included on a voluntary basis in this online cross-sectional questionnaire-survey using an internal member-only social media platform of TTS. The questionnaire form elicited items on sociodemographic characteristics, occupational characteristics and gender discrimination in work life (general opinions, attitudes and exposure).

Results

Female doctors (vs. males) were less likely to be a thoracic surgeon (13.8% vs. 34.5%, p < 0.05) and a professor of thoracic surgery (0.0% vs. 26.7% vs. p < 0.05), and more likely to consider housework as a considerable burden (89.8 vs. 73.6%, p = 0.02) and the significant role of discriminatory, negative and dissuasive attitudes of male physicians in their career choice (67.6 vs. 35.6%, p = 0.039). Male doctors were more likely to considered that men are more successful in specialties that require active physical strength (65.5 vs. 27.7%, p = 0.005) and those with very long working hours and heavy shifts (57.5 vs. 39.4%, p = 0.001). Female thoracic surgeons were more likely than males to consider that specialties with very long working hours and heavy shifts are more suitable for men (26.9 vs. 6.0%, p = 0.027) and men are given priority in academic career promotion (64.0 vs. 13.3%, p < 0.001). Younger (vs. older) females reported higher rate of exposure to gender discrimination (p = 0.041) and considerable impact of social roles on the specialty (p = 0.007), while female doctors working as a resident (33.8%) and a specialist (50.05%) indicated higher rate of exposure to gender discrimination during their career (p = 0.024).

Conclusion

In conclusion, our findings revealed that exposure to gender discrimination in work life was more commonly expressed by female members of TTS, particularly in terms of burden of social roles, career advancement options and leadership positions, along with significant role of discriminatory, negative and dissuasive attitudes of male physicians in their career choice. Accordingly, women remain underrepresented in thoracic surgery, particularly in the academic rank of full professor and in leadership positions with inability to promote after a definite step in their careers.

Family Planning in Cardiothoracic Surgery: A Comparison Between Male and Female Surgeons

BACKGROUND

Although work-family balance impacts specialty selection for medical students of both sexes, pregnancy and childbearing experiences are unique to women. Cardiothoracic surgery, with low female representation, must prioritize these issues to support women entering the field. This study compared family planning experiences between male and female cardiothoracic surgeons.

METHODS

An anonymous, self-administered questionnaire was distributed to cardiothoracic trainees and surgeons from January to June 2023. Descriptive data were collected on family planning perceptions, assisted reproductive technology use, number of children, and pregnancy characteristics (maternal age, complications, miscarriage). Male surgeons reported pregnancy outcomes of their childbearing partners.

RESULTS

Of 378 participants, 45.77% were women, and mean age was 44.40 ± 11.59 years. Compared with male surgeons, female surgeons were more often deterred from pursuing cardiothoracic surgery due to a desire to have children (41.62% vs 22.93%, P = .004), more often used assisted reproductive technology (32.37% vs 15.12%, P < .001), had fewer children (1.92 vs 2.48, P < .001), and had fewer children than desired (40.81% vs 25.14%, P < .001). Compared with partners of male surgeons, female surgeons were older at first live birth (34 vs 32 years, P < .001). Among female surgeons, 73 (42.40%) experienced 155 miscarriages, and 54 (74%) reported taking 0 days off from work after miscarriage.

CONCLUSIONS

The path to parenthood varies significantly by sex for cardiothoracic surgeons, with women more likely to be deterred from the profession by perceived challenges. Policies that promote work-family integration, support maternal-fetal health, and provide support following fetal loss are needed.

Diversity in the Cardiothoracic Surgery Workforce: What I Can Do

Within the cardiothoracic surgery workforce, there are significant gaps in the numbers of women and underrepresented in medicine minorities, but some progress has been made in gender diversity at the resident level. Individual surgeons play an important role in combatting discrimination and harassment, while also promoting women and minorities through mentorship and sponsorship. More importantly, a multifaceted and structured approach is needed to increase diversity at the institutional level with strategies to create a culture of inclusion, working to retain underrepresented minority and female surgeons, and eliminating bias in the recruitment process.

Workforce diversity in cardiothoracic surgery: An examination of recent demographic changes and the training pathway

INTRODUCTION

The purpose of our study was to examine changes in the demographic makeup of resident physicians in integrated 6-year cardiothoracic surgery and traditional thoracic surgery residency programs from 2013 to 2022 compared with other surgical subspecialties and determine potential leaks in the training pathway.

METHODS

Data from US Graduate Medical Education reports from 2013 to 2022 and medical student enrollment data from the Association of American Medical Colleges were obtained. Average percentages of women and underrepresented minorities were calculated in 2 5-year intervals: 2013 to 2017 and 2018 to 2022. Average percentages of women, Black, and Hispanic medical students and residents were calculated for the 2019 to 2022 period. Pearson χ2 tests were conducted to determine significant differences in proportions of women, Black/African American, and Hispanic trainees across time (α = 0.05).

RESULTS

Thoracic surgery and I6 residents saw a significant increase in the proportion of women trainees across the 2 time periods (19.9% (210 out of 1055) to 24.6% (287 out of 1169) (P < .01) and 24.1% (143 out of 592) to 28.9% (330 out of 1142) (P < .05)), respectively. There was no significant change in the proportion of Black and Hispanic trainees in thoracic surgery fellowship or integrated 6-year cardiothoracic residency programs. Hispanic trainees were the only group whose proportion of cardiothoracic surgery trainees was not significantly lower than their medical school proportion. Women and Black trainees had significantly lower proportions of thoracic surgery residents and integrated 6-year cardiothoracic residency program residents than their proportions in medical school (P < .01).

CONCLUSIONS

Cardiothoracic surgery has not significantly increased the number of Black and Hispanic trainees during the past decade. The lower proportion of Blacks and women in thoracic surgery residency and fellowship programs compared with their proportion in medical schools is concerning and is an opportunity for intervention.

Dissuasion in women surgical trainees pursuing cardiothoracic surgery

BACKGROUND

The reasons for persistent gender disparity in cardiothoracic surgery (CTS) are multifaceted. The objective of this paper is to understand if and why women surgical trainees are dissuaded from pursuing CTS.

METHODS

A survey was sent to self-identified women participating in Women in Thoracic Surgery speed mentoring. Statistical analysis was performed to determine dissuasion rates. Open-ended responses describing examples of dissuasion were characterized and categorized.

RESULTS

Of all participants, 76 ​% (163/215) reported dissuasion from a CTS career. Third- and fourth-year medical students experienced the highest rate by training (81 ​%, 48/59) and those interested in Congenital CTS experienced the highest rate based on subspecialty interest (94 ​%, 17/18). The most cited dissuasion examples included work/life balance, lifestyle with children, and gender.

CONCLUSIONS

Most women surveyed had been dissuaded from pursuing a career in CTS. Examples of dissuasion provided are heavily associated with traditional gender roles, supporting the presence of continued gender bias in CTS.

Career satisfaction in women surgeons: A systematic review and meta-analysis

BACKGROUND

Career satisfaction among women surgeons have been well-reported in literature. This study provides a comprehensive review to understand career satisfaction and its contributory factors among female surgeons.

METHODS

PRISMA guidelines were utilized to extract studies for systematic review and meta-analysis. Outcomes assessed included surgical career satisfaction, career reconsideration, work-life balance, and gender bias and discrimination (GBD). Odds ratios were calculated comparing women to men for each outcome.

RESULTS

This study demonstrated that female surgeons were less likely to endorse overall career satisfaction (OR, 0.68; 95% CI, 0.55-0.85) and work-life balance satisfaction (OR, 0.61; 95% CI, 0.40-0.92) compared to male surgeons. It also revealed that women surgeons were more likely to report workplace GBD (OR, 13.82; 95% CI, 4.37-43.65).

CONCLUSIONS

Future interventions may be necessary to increase career and work-life balance satisfaction among women surgeons while reconciling the need to ensure they are adequately informed of the obligations of a surgical career.

Integrated cardiothoracic surgery match: Trends among applicants compared with other surgical subspecialties

OBJECTIVE

The objective of this study was to evaluate trends, qualifications, race/ethnicity, and gender of applicants to integrated cardiothoracic (CT I-6) residency programs and compare them with other competitive surgical subspecialties.

METHODS

Data were collected from the National Residency Matching Program, Electronic Residency Application Service, and Association of American Medical Colleges for thoracic surgery, orthopedic surgery, neurological surgery, otolaryngology (ENT), plastic surgery, and vascular surgery for 2010 t0 2020. Applicant gender, race/ethnicity, Alpha Omega Alpha (AOA) membership, United States Medical Licensing Examination scores, research productivity, and graduation from a top-40 medical school were analyzed.

RESULTS

From 2010 to 2020, CT I-6 experienced growth in postgraduate year 1 positions (280.0%), total applicants (62.2%), and US senior applicants (59.2%). No growth in CT I-6 positions (38) or programs (29) occurred from 2016 to 2020. CT I-6 had the lowest match rates among total applicants (31.7%) and US seniors (41.0%) in 2020. CT I-6 had fewer female applicants compared with ENT (P < .001) and plastic surgery (P < .001), but more than orthopedic surgery (P < .001). Although most CT I-6 US applicants self-identified as White (75.0%), there were more Asian applicants compared with applicants for orthopedic surgery (P < .001), ENT (P < .001), plastic surgery (P < .001), and neurological surgery (P < .01). Matched applicants averaged the highest Step 2-Clinical Knowledge scores (255.1), AOA membership (48.5%), and graduation rates from top-40 medical schools (54.5%).

CONCLUSIONS

Despite tremendous growth in positions, CT I-6 has consistently been the most difficult surgical subspecialty to match. CT I-6 has recently attracted an increasingly diverse applicant pool. For the 2019 to 2020 National Residency Matching Program Match Cycle, successful applicants had the highest Step 2-Clinical Knowledge scores, AOA membership rates, and graduation rates from a top-40 medical school among all surgical subspecialties examined.

Surgeons' Perspectives on Valve Surgery in People With Drug Use-Associated Infective Endocarditis

BACKGROUND

Hospitalizations for drug-use associated infective endocarditis (DUA-IE) have led to increasing surgical consultation for valve replacement. Cardiothoracic surgeons' perspectives about the process of decision making around operation for people with DUA-IE are largely unknown.

METHODS

This multisite semiqualitative study sought to gather the perspectives of cardiothoracic surgeons on initial and repeat valve surgery for people with DUA-IE through purposeful sampling of surgeons at 7 hospitals: University of Alabama, Tufts Medical Center, Boston Medical Center, Massachusetts General Hospital, University of North Carolina-Chapel Hill, Vanderbilt University Medical Center, and Rhode Island Hospital-Brown University.

RESULTS

Nineteen cardiothoracic surgeons (53% acceptance) were interviewed. Perceptions of the drivers of addiction varied as well as approaches to repeat valve operations. There were mixed views on multidisciplinary meetings, although many surgeons expressed an interest in more efficient meetings and more intensive postoperative and posthospitalization multidisciplinary care.

CONCLUSIONS

Cardiothoracic surgeons are emotionally and professionally impacted by making decisions about whether to perform valve operation for people with DUA-IE. The use of efficient, agenda-based multidisciplinary care teams is an actionable solution to improve cross-disciplinary partnerships and outcomes for people with DUA-IE.

Denis-Katz H, Iyer H, Padeanu S, Adibfar A, Valiquette C, Morzycki A, Janis JE, Thibaudeau S. Gender Equality in Plastic Surgery Training: A Canadian Nationwide Cross-sectional Analysis

Introduction: One of the important factors in achieving gender equity is ensuring equitable surgical training for all. Previous studies have shown that females get significantly lower surgical exposure than males in certain surgical specialties. Gender gap in surgical exposure has never been assessed in plastic surgery. To that end, the goal of this study was to assess if there are any differences in plastic surgery training between male and female residents. Methods: A survey was sent to all plastic surgery residency programs in Canada to assess the No. of surgeries residents operated on as a co-surgeon or primary assistant during their training. The survey also assessed career goals, level of interest in the specialty, and subjective perception of gender bias. Results: A total of 89 plastic surgery residents (59.3% participation rate) completed the survey and were included in the study. The average No. of reconstructive cases residents operated on as a co-surgeon or primary assistant was 245 ± 312 cases. There was no difference in either reconstructive or aesthetic surgery case logs between male and female residents (p > .05). However, a significantly larger proportion of females (39%) compared to males (4%) felt that their gender limited their exposure to surgical cases and led to a worsening of their overall surgical training (p < .001). Finally, a larger proportion of male residents were interested in academic careers while a larger proportion of female residents were interested in a community practice (p = .024). Conclusion: While there is no evidence of differences in the volume of logged cases between genders, female surgical residents still feel that their respective gender limits their overall surgical training. Gender inequalities in training should be addressed by residency programs.

Report of the 2022 Society of Thoracic Surgeons Congenital Heart Surgery Practice Survey

BACKGROUND

The Society of Thoracic Surgeons Workforce on Congenital Surgery performed a practice survey to analyze contemporary data.

METHODS

An electronic survey was sent to congenital heart surgeons in North America. Details on demographics, training paradigm, clinical practice, and work satisfaction were queried, tabulated, and analyzed.

RESULTS

Of 312 unique contacts, 201 (64.4%) responded. Of these, 178 (89%) were practicing. The median age was 52 years (interquartile range, 43, 59 years), and 157 (88%) were male. The number of female respondents increased from 12 (7%) in 2015 to 18 (11%) at present. Practice composition was predominantly mixed pediatric and adult (141; 79%), although 15 (8%) surgeons practiced exclusively pediatric surgery. Most surgeons (154; 87%) reported performing the Society of Thoracic Surgeons-European Association for Cardio-Thoracic Surgery category 4 and 5 procedures. One-fourth (42; 24%) reported performing fewer than 50 pediatric cases per year, and 18 (10%) stated that their primary role was as a surgical assistant. Individual surgeon case volume was most commonly 100 to 149 total cases (29%). Although one-half (91; 51%) reported their volume as being "just right," 74 (42%) reported that their case volume was "too small." Seventy-six (43%) reported too many surgeons in their region. Of the 201 practicing surgeons, 30 (14.9%) plan retirement in the next 5 years. Most described career satisfaction, with 102 (57%) being very satisfied and 48 (27%) somewhat satisfied.

CONCLUSIONS

Although most congenital heart surgeons in North America are satisfied with their careers, more than 40% believe that their caseload is inadequate and that there are too many surgeons in their region. Further analysis is warranted regarding career dissatisfaction and diversity.

You are in charge now: exploration of educational relationships between anaesthetic trainees and their supervising specialists

Background

Much of the education during anaesthesia training occurs in the workplace where trainees work under the close supervision of a more senior anaesthetist. Trainee anaesthetists are exposed to multiple supervisors with whom they form educational and supervisory relationships over the course of their training. Surprisingly little research has been conducted to explore the factors behind the development and maintenance of these relationships. This study explores the process of how education occurs in the workplace by examining the relationship from the perspective of both trainees and specialists.

Methods

This is an exploratory qualitative study. Eight trainee and 10 specialist anaesthetists participated in an individual semi-structured interview. The data were analysed thematically by each of the authors to generate themes.

Results

Six themes were identified in the analysis: (1) sizing up; (2) negotiated autonomy; (3) working closely together; (4) workplace practices; (5) education being valued; and (6) gender. A conceptual model to illustrate the relationships between the six themes was developed.

Conclusions

Supervisory relationships were viewed positively by participants despite impediments such as lack of continuity and busy clinical environments. But there were tensions, particularly in balancing trainee autonomy with patient safety. A nuanced 'sizing up' process, with negotiation of autonomy, was described by both supervisors and trainees. Our findings may support supervisory relationships to reach this ideal more effectively.

Knowledge and Perception of Cardiac Surgery Among Medical Students in the Western Region of Saudi Arabia

Introduction Medical undergraduates' educational programs and clinical experiences are important factors in determining their preferred future career path. Unfortunately, the cardiac surgery specialty is experiencing a decline in medical graduates due to many influencing factors as a lack of involvement with the cardiac surgery specialty and a lack of training centers. A detailed evaluation of the student's knowledge and perceptions about cardiac surgery is required to assess the career options in a specialty like cardiac surgery. This study aims to evaluate medical students' knowledge and perceptions of the cardiac surgical specialty. Methodology This is a cross-sectional study that was approved by the institutional research board of Umm Al-Qura University. Adapting a previously published questionnaire data to fit our scope and aims. Necessary adjustments were made adhering to the cardiac surgery experts' instructions. Data was collected through an electronic survey by Google Forms and distributed through social media apps.  Results A total of 637 students participated in the study. The majority (75.2%) admitted to having little knowledge of the specialty of cardiac surgery, and 62.8% reported no interest in it. In addition, 88.9% had never done a cardiac surgery rotation before. One of the top concerns of becoming a cardiac surgeon (45.2%) was the amount of time spent studying and working. Conclusion The findings of our study highlight the value of using innovative and targeted learning methods for medical students to enhance their knowledge and pique their interest in cardiac surgery since it was evident that there was a misperception regarding the scope of cases dealt with by cardiac surgery as opposed to other surgical subspecialists.

Practice patterns of female cardiothoracic surgeons older than age 58 years: Are we making progress?

OBJECTIVE

Women remain a small minority of cardiothoracic surgeons, and within adult cardiac surgery, the gender gap widens. This study examines the career pathway and trajectory of female adult cardiac surgeons.

METHODS

Female cardiothoracic surgeons were identified from the American Board of Thoracic Surgery diplomates over 58 years. Publicly available information was obtained to determine years in practice, practice type, academic and leadership title(s), and location of practice.

RESULTS

The average number of years in practice for female adult cardiac surgeons was 13.1. Those categorized as adult cardiac surgeons composed 25.4% (n = 90) of all female cardiothoracic diplomates and 134 (37.9%) were categorized as other subspecialty practice. Of the adult cardiac surgeons, 33.3% (n = 30) practiced privately and the remainder in academic practice. Academic titles were held by 47.8% (43 out of 90) and 30% (27 out of 90) held a position of leadership. Of those in academic practice, 25% (11 out of 42) are titled professor, whereas 43% (18 out of 42) are assistant professors. Most commonly, those in positions of leadership held the title "director," which reflects 37% (10 out of 27) of individuals. Practice locations were distributed throughout the United States, with the highest number in the northeast (26.7%).

CONCLUSIONS

Only a small portion of female cardiothoracic surgeons pursue a career in adult cardiac surgery compared to their male counterparts. From 1999 to 2009, 1300 individuals were board certified cardiothoracic surgeons, of whom only 103 (7.9%) were female. Of these, the majority of female cardiothoracic surgeons entered academic practice. Although the overall number of practicing female adult cardiac surgeons has increased with a growth rate of 10.7%, this number remains extremely low. A discrepancy remains between gender representation of academic titles and leadership positions. Although the field has increased female representation over the past few decades, work remains to ensure all potential talent is encouraged and supported.

Comparing Match Outcomes in a Surgical Subspecialty: Independent Versus Integrated Training Pathways

OBJECTIVE

In recent years, the Thoracic Surgery Match (TSM) has become increasingly competitive. The purpose of this study was to compare recent trends in application and match rates in the TSM by training pathway.

DESIGN

This was a retrospective cohort study of all applicants to Integrated and Independent pathways for Thoracic Surgery training (2008-2021). Chi square tests were used to elucidate temporal trends and make comparisons by training pathway.

SETTING

Accreditation Council for Graduate Medical Education (ACGME)-accredited Thoracic Surgery training programs in the United States.

PARTICIPANTS

1500 Independent and 1242 Integrated pathway applicants for Thoracic Surgery training.

RESULTS

From 2008 to 2021, the annual match rate decreased from 91% to 71% in the Independent pathway (p < 0.001). This was driven by a decrease in the number of training positions (130-101, 22% decrease) and increase in number of applicants (96-140, 46% increase). In the Integrated pathway, the annual match rate increased from 33% to 35% (p < 0.001) as did the number of training positions (3 to 46, 1430% increase) and applicants (9-129, 1333% increase). During each year, match rates in the Independent pathway exceeded those in the Integrated pathway (p < 0.001). U.S. Allopathic graduates had higher match rates than non-U.S. Allopathic graduates for both Integrated and Independent training pathways. The percentage of applicants in the Independent pathway matching at one of their top 3 choices decreased from 73% to 40% (p < 0.001). The percentage of Independent thoracic surgery training positions that went unmatched decreased from 28% to 2% (p < 0.001). This percentage was stable at an average of 1% in the Integrated pathway (p > 0.05).

CONCLUSIONS

The TSM has become increasingly competitive for Independent pathway applicants and remains ultracompetitive for Integrated pathway applicants. More research is needed to understand disparities in match rates by Thoracic Surgery training pathway.

Gender Bias in the Evaluation of Surgical Performance: Results of a Prospective Randomized Trial

OBJECTIVE

The study aims to determine the influence of trainee gender on assessments of coronary anastomosis performance.

SUMMARY OF BACKGROUND DATA

Understanding the impact of gender bias on the evaluation of trainees may enable us to identify and utilize assessment tools that are less susceptible to potential bias.

METHODS

Cardiothoracic surgeons were randomized to review the video performance of trainees who were described by either male or female pronouns. All participants viewed the same video of a coronary anastomosis and were asked to grade technique using either a Checklist or Global Rating Scale (GRS). Effect of trainee gender on scores by respondent demographic was evaluated using regression analyses. Inter-rater reliability was assessed using the Cronbach's alpha.

RESULTS

103 cardiothoracic surgeons completed the Checklist (trainee gender: male n=50, female n=53) and 112 completed the GRS (trainee gender: male n=56, female n=56). For the Checklist, male cardiothoracic surgeons who were in practice <10 years ( P = 0.036) and involved in training residents ( P = 0.049) were more likely to score male trainees higher than female trainees. The GRS demonstrated high inter-rater reliability across male and female trainees by years and scope of practice for the respondent (alpha >0.900) when compared to the Checklist assessment tool.

CONCLUSIONS

Early career male surgeons may exhibit gender bias against women when evaluating trainee performance of coronary anastomoses. The GRS demonstrates higher interrater reliability and robustness against gender bias in the assessment of technical performance than the Checklist, and such scales should be emphasized in educational evaluations.

Women in Thoracic Surgery 2020 Update-Subspecialty and Work-Life Balance Analysis

BACKGROUND

While women comprise nearly half of medical school graduates, they remain underrepresented in cardiothoracic (CT) surgery. To better understand ongoing barriers, we aimed to delineate issues relevant to the CT subspecialities, emphasizing personal life.

METHODS

An anonymous Research Electronic Data Capture (REDCap; hosted at Indiana University School of Medicine) survey link was emailed to female diplomats of the American Board of Thoracic Surgeons (ABTS). The survey included questions on demographics, professional accolades, practice details, and personal life. Survey responses were compared across subspecialities using χ² testing.

RESULTS

Of 354 female ABTS diplomats, we contacted 309, and 176 (57%) completed the survey. By subspecialty, 42% practice thoracic, 26% adult cardiac, and 10% congenital cardiac; 19% report a mixed practice. The subspecialties differed in length of training (congenital-the longest), practice location (mixed practice-less urban), and academic rank (thoracic-most full professors at 17%), but were largely similar in their personal lives. Among all respondents, 65% are in a committed relationship, but 40% felt that being a CT surgeon negatively impacted their ability to find a partner. Sixty percent have children, but 31% of those with children reported using assisted reproductive technology, surrogacy, or adoption. The number with leadership roles (eg, division chief, committee chair of national organization) did not differ among subspecialities, but was low, ranging from 0 to <30%.

CONCLUSIONS

Women remain underrepresented in CT surgery, particularly in the academic rank of full professor and in leadership positions. We advocate for scholarship and mentorship opportunities to encourage women to enter the field, increased female leadership, and policies to enable families.

The utilization of educational resources published by the Thoracic Surgery Residents Association

OBJECTIVE

The Thoracic Surgery Residents Association (TSRA) is a trainee-led cardiothoracic surgery organization in North America that has published a multitude of educational resources. However, the utilization of these resources remains unknown.

METHODS

Surveys were constructed, pilot-tested, and emailed to 527 current cardiothoracic trainees (12 questions) and 780 former trainees who graduated between 2012 and 2019 (16 questions). The surveys assessed the utilization of TSRA educational resources in preparing for clinical practice as well as in-training and American Board of Thoracic Surgery (ABTS) certification examinations.

RESULTS

A total of 143 (27%) current trainees and 180 (23%) recent graduates responded. A higher proportion of recent graduates compared with current trainees identified as male (84% vs 66%; P = .001) and graduated from 2- or 3-year traditional training programs (81% vs 41%; P < .001), compared with integrated 6-year (8% vs 49%; P < .001) or 4 + 3 (11% vs 10%; P = .82) pathways. Current trainees most commonly used TSRA resources to prepare for the in-training exam (75%) and operations (73%). Recent graduates most commonly used them to prepare for Oral and/or Written Board Exams (92%) and the in-training exam (89%). Among recent graduates who passed the ABTS Oral Board Exam on the first attempt, 82% (97/118) used TSRA resources to prepare, versus only 48% (25/52) of recent graduates who passed after multiple attempts, failed, have not taken the exam, or preferred not to answer (P < .001).

CONCLUSIONS

Current cardiothoracic trainees and recent graduates have utilized TSRA educational resources extensively, including to prepare for in-training and ABTS Board examinations.

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.

Considerations for a Holistic Model in Evaluating Medical Students for Cardiothoracic Surgical Residency

Program directors are tasked with selecting whom they think will be the best fit for residency and the next leaders of the field. While numerical metrics have played a vital role in this process, recent changes to student evaluation are reducing the availability of these metrics. This poses unique challenges for both applicants and program directors. Here we discuss how this will likely shift the focus on other parts of the application and the consequences (good and bad) of doing so.

Women in neurointervention, a gender gap? Results of a prospective online survey

BACKGROUND AND PURPOSE

Women's representation in medicine has increased over time yet the proportion of women practicing neurointervention remains low. We conducted an anonymous online survey through which we could explore the gender gap in neurointervention, identify potential issues, difficulties, or obstacles women might face, and evaluate if men encounter similar issues.

METHODS

An online questionnaire was designed in SurveyMonkey®. Invitation to participate was emailed through national and international neurointerventional societies as well as directly through private mailing lists to men and women working in neurointervention. Responses were collected from 10 May 2019 to 10 September 2019.

RESULTS

There were 295 complete responses, 173 (59%) male and 122 (41%) female. Most respondents (83%) fell within age categories 35-60 years, with representation from 40 countries across five continents. In all 95% were working full time, 73% had worked as a neurointerventionalist for >6 years, 77% worked in University-affiliated teaching institutions. Almost half of the respondents indicated no female neurointerventionalist worked in their center. Female respondents were younger and age-adjusted analysis was undertaken. Significantly fewer females than males were married and had children. Significantly fewer females held supervisory roles, held academic titles, and significantly less had a mentor. Females were less satisfied in their careers. More females felt they receive less recognition than colleagues of the opposite sex. Males had a greater proportion of work time dedicated to neurointervention. Similar proportions of both genders experienced bullying in work (40%-47%); however, sexual harassment was more common for females. There were no differences between genders in how they dealt with complications or their effects on mental well-being.

CONCLUSION

There are many potential reasons why women are underrepresented in neurointervention, however, the literature suggests this is not unique to our specialty. Multiple long-term strategies will be necessary to address these issues, some of which are discussed in the article.

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.

Longitudinal analysis of National Institutes of Health funding for academic thoracic surgeons

OBJECTIVE

National Institutes of Health (NIH) funding for academic (noncardiac) thoracic surgeons at the top-140 NIH-funded institutes in the United States was assessed. We hypothesized that thoracic surgeons have difficulty in obtaining NIH funding in a difficult funding climate.

METHODS

The top-140 NIH-funded institutes' faculty pages were searched for noncardiac thoracic surgeons. Surgeon data, including gender, academic rank, and postfellowship training were recorded. These surgeons were then queried in NIH Research Portfolio Online Reporting Tools Expenditures and Results for their funding history. Analysis of the resulting grants (1980-2019) included grant type, funding amount, project start/end dates, publications, and a citation-based Grant Impact Metric to evaluate productivity.

RESULTS

A total of 395 general thoracic surgeons were evaluated with 63 (16%) receiving NIH funding. These 63 surgeons received 136 grants totaling $228 million, resulting in 1772 publications, and generating more than 50,000 citations. Thoracic surgeons have obtained NIH funding at an increasing rate (1980-2019); however, they have a low percentage of R01 renewal (17.3%). NIH-funded thoracic surgeons were more likely to have a higher professorship level. Thoracic surgeons perform similarly to other physician-scientists in converting K-Awards into R01 funding.

CONCLUSIONS

Contrary to our hypothesis, thoracic surgeons have received more NIH funding over time. Thoracic surgeons are able to fill the roles of modern surgeon-scientists by obtaining NIH funding during an era of increasing clinical demands. The NIH should continue to support this mission.

The impact of gender bias in cardiothoracic surgery in Europe: a European Society of Thoracic Surgeons and European Association for Cardio-Thoracic Surgery survey

OBJECTIVES

The European Society of Thoracic Surgeons and the European Association for Cardio-Thoracic Surgery designed a questionnaire to assess the impact of gender bias on a cardiothoracic surgery career.

METHODS

A 46-item survey investigating gender bias was designed using online survey software from December 2020 to January 2021. All European Society of Thoracic Surgeons and European Association for Cardio-Thoracic Surgery members and non-members included in the mailing lists were invited to complete an electronic survey. Descriptive statistics and a comparison between gender groups were performed.

RESULTS

Our overall response rate was 11.5% (1118/9764), of which 36.14% were women and 63.69% were men. Women were more likely to be younger than men (P < 0.0001). A total of 66% of the women reported having no children compared to only 19% of the men (P < 0.0001). Only 6% of women vs 22% of men were professors. More women (72%) also reported never having been a formal mentor themselves compared to men (38%, P < 0.0001). A total of 35% of female respondents considered leaving surgery because of episodes of discrimination compared to 13% of men; 67% of women said that they experienced being unfairly treated due to gender discrimination. Of the male surgeons, 31% reported that they were very satisfied with their career compared to only 17% of women (P < 0.0001).

CONCLUSIONS

Women in cardiothoracic surgery reported significantly high rates of experiences with bias that may prevent qualified women from advancing to positions of leadership. Efforts to mitigate bias and support the professional development of women are at the centre of newly formed European committees.

Trends in Female Authorship in High Impact Surgical Journals Between 2008 and 2018

OBJECTIVE

This study evaluates the distribution of authorship by sex over the last 10 years among the top 25 surgical journals.

SUMMARY OF BACKGROUND DATA

Despite an increase in women entering surgical residency, there remains a sex disparity in surgical leadership. Scholarly activity is the foundation for academic promotion. However, few studies have evaluated productivity by sex in surgical literature.

METHODS

Original research in the 25 highest-impact general surgery/subspecialty journals were included (1/2008-5/2018). Journals with <70% identified author sex were excluded. Articles were categorized by sex of first, last, and overall authorship. We examined changes in proportions of female first, last, and overall authorship over time, and analyzed the correlation between these measurements and journal impact factor.

RESULTS

There were 71,867 articles from 19 journals included. Sex was successfully predicted for 87.3% of authors (79.1%-92.5%). There were significant increases in the overall percentage of female authors (β = 0.55, P < 0.001), female first authors (β = 0.97, P < 0.001), and female last authors (β = 0.53, P < 0.001) over the study period. Notably, all cardiothoracic subspecialty journals did not significantly increase the proportion of female last authors over the study period. There were no correlations between journal impact factor and percentage of overall female authors (rs = 0.39, P = 0.09), female first authors (rs = 0.29, P = 0.22), or female last author (rs = 0.35, P = 0.13).

CONCLUSIONS

This study identifies continued but slow improvement in female authorship of high-impact surgical journals during the contemporary era. However, the improvement was more apparent in the first compared to senior author positions.

60 Years After the First Woman Cardiac Surgeon: We Still Need More Women in Cardiac Surgery

In 1960, Dr Nina Starr Braunwald became the first woman to perform open heart surgery. Sixty years later, despite the fact that women outnumbered men in American medical school in 2017, men still dominate the field of cardiac surgery. Women surgeons remain underrepresented in cardiac surgery; 11% of practicing cardiac surgeons in Canada were women in 2015, and 6% of practicing adult cardiac surgeons in the US were women in 2019. Although women remain a minority in other surgical specialties also, cardiothoracic surgery remains one of the most unevenly–gender distributed specialties. Why are there so few women cardiac surgeons, and why does it matter? Evidence is emerging regarding the benefits of diversity for a variety of industries, including healthcare. In order to attract and retain the best talent, we must make the cardiac surgery environment more diverse, equitable, and inclusive. Some causes of perpetuation of the gender gap have been documented in the literature—these include uneven compensation and career advancement opportunities, outdated views on family dynamics, and disproportionate scrutiny of women surgeons, causing additional workplace frictions for women. Diversity is an organizational strength, and gender-diverse institutions are more likely to outperform their non-gender-diverse counterparts. Modifiable issues perpetuate the gender gap, and mentorship is key in helping attract, develop, and retain the best and brightest within cardiac surgery. Facilitating mentorship opportunities is key to reducing barriers and bridging the gap.

Status of women in congenital heart surgery: Results from a national survey

OBJECTIVE

Gender disparity in cardiothoracic surgery, but not specifically in congenital heart surgery, has been a growing focus. The aim of this study was to describe the experiences related to gender for women in this field.

METHODS

This cross-sectional survey was designed to assess gender perception in 5 domains: training, professional career, clinical practice, personal life, and career outlook. Inclusion criteria were women who trained and are practicing congenital heart surgery in the United States.

RESULTS

Eighteen women were identified with a survey response rate of 94% (17/18). The majority of respondents were aged more than 40 years (94%) and White (69%), chose their career in congenital heart surgery during residency (77%), and completed more than 10 years of postgraduate education (56%). More than half were discouraged from congenital heart surgery because of their gender and reported its negative impact on their ability to obtain their first job. The need to "outperform" their male colleagues was nearly universal (94%), and gender pay disparity was reported by 81%. The majority (65%) reported sexual harassment both during surgical training and as staff surgeons.

CONCLUSIONS

This survey highlights many areas (discouragement due to gender, sexual harassment, and gender disparities in pay and leadership opportunities) that women may perceive as barriers to a successful career in congenital heart surgery. There is an increasing call to action to mitigate these hurdles for women, both to enter and succeed. It is encouraging that the women surveyed would repeat their career choice and are actively mentoring other women to join this field.

Health Care Policy and Congenital Heart Disease: 2020 Focus on Our 2030 Future

The congenital heart care community faces a myriad of public health issues that act as barriers toward optimum patient outcomes. In this article, we attempt to define advocacy and policy initiatives meant to spotlight and potentially address these challenges. Issues are organized into the following 3 key facets of our community: patient population, health care delivery, and workforce. We discuss the social determinants of health and health care disparities that affect patients in the community that require the attention of policy makers. Furthermore, we highlight the many needs of the growing adults with congenital heart disease and those with comorbidities, highlighting concerns regarding the inequities in access to cardiac care and the need for multidisciplinary care. We also recognize the problems of transparency in outcomes reporting and the promising application of telehealth. Finally, we highlight the training of providers, measures of productivity, diversity in the workforce, and the importance of patient-family centered organizations in advocating for patients. Although all of these issues remain relevant to many subspecialties in medicine, this article attempts to illustrate the unique needs of this population and highlight ways in which to work together to address important opportunities for change in the cardiac care community and beyond. This article provides a framework for policy and advocacy efforts for the next decade.

Gender imbalance amongst promotion and leadership in academic surgical programs in Canada: A cross-sectional Investigation

BACKGROUND

Women are underrepresented at higher levels of promotion or leadership despite the increasing number of women physicians. In surgery, this has been compounded by historical underrepresentation. With a nation-wide focus on the importance of diversity, our aim was to provide a current snapshot of gender representation in Canadian universities.

METHODS

This cross-sectional online website review assessed the current faculty listings for 17 university-affiliated academic surgical training departments across Canada in the 2019/2020 academic year. Gender diversity of academic surgical faculty was assessed across surgical disciplines. Additionally, gender diversity in career advancement, as described by published leadership roles, promotion and faculty appointment, was analyzed.

RESULTS

Women surgeons are underrepresented across Canadian surgical specialties (totals: 2,689 men versus 531 women). There are significant differences in the gender representation of surgeons between specialties and between universities, regardless of specialty. Women surgeons had a much lower likelihood of being at the highest levels of promotion (OR: 0.269, 95% CI: 0.179-0.405). Men surgeons were statistically more likely to hold academic leadership positions than women (p = 0.0002). Women surgeons had a much lower likelihood of being at the highest levels of leadership (OR: 0.372, 95% CI: 0.216-0.641).

DISCUSSION

This study demonstrates that women surgeons are significantly underrepresented at the highest levels of academic promotion and leadership in Canada. Our findings allow for a direct comparison between Canadian surgical subspecialties and universities. Individual institutions can use these data to critically appraise diversity policies already in place, assess their workforce and apply a metric from which change can be measured.

Lack of Awareness of Reimbursement and Compensation Models amongst Cardiothoracic Surgery Trainees

BACKGROUND

The objective of this study was to identify trainee knowledge gaps in reimbursement and compensation, determine the perceived importance of understanding these topics, and to explore if the Thoracic Surgery Curriculum needs additional educational material.

METHODS

The Thoracic Surgical Residents Association (TSRA) Executive committee selected the research proposal and distributed an anonymous electronic survey to 531 ACGME cardiothoracic surgery trainees. Standard descriptive statistics and regression analyses were performed.

RESULTS

114 responses were collected (response rate 21.5%). Most trainees understand little or not at all about how attending surgeons are reimbursed (n=74, 69%). Most trainees reported knowing little or nothing about pay-for-performance compensation (n=73, 67%), bundled care (n=82, 75%) or value-based reimbursement (n=84, 77%). Only approximately 20% of trainees were accurate in estimating surgeon reimbursement for three common cardiothoracic surgery procedures to within 20% of the true reimbursement value, while approximately 30% were accurate to within 50% of the true reimbursement value. No respondent characteristics were found to be associated with a more or less accurate reimbursement response. Additionally, 81% of trainees responded that by the conclusion of training, understanding surgeon reimbursement is very important or extremely important (n=87) and 90% of trainees either somewhat agree or strongly agree with including these topics in the Thoracic Surgical Curriculum (n=95).

CONCLUSIONS

Despite acknowledging the importance of understanding physician compensation and reimbursement, cardiothoracic surgery trainees do not understand how the current models work. This study exemplifies the need for a succinct curriculum in this domain for trainees nationwide.

Demographic Landscape of Cardiothoracic Surgeons and Residents at United States Training Programs

BACKGROUND

Recruiting and promoting women and racial/ethnic minorities could help enhance diversity and inclusion in the academic cardiothoracic (CT) surgery workforce. However, the demographics of trainees and faculty at US training programs have not yet been studied.

METHODS

Traditional, integrated (I-6), and fast-track (4+3) programs listed in the Accreditation Council for Graduate Medical Education (ACGME) public database were analyzed. Demographics of trainees and surgeons, including gender, race/ethnicity, subspecialty, and academic appointment (if applicable), were obtained from ACGME Data Resource Books, institutional websites, and public profiles. Chi-square and Cochran-Armitage trend tests were performed.

RESULTS

In July 2020, 78 institutions had at least one CT surgery training program; 40 (51%) had only a traditional program, 20 (26%) traditional and I-6, 6 (8%) all three types of program, and 4 (5%) only I-6. The proportion of female trainees increased significantly from 2011 to 2019 (19% vs 24%, p<0.001), with female I-6 trainees outnumbering female traditional trainees since 2018. Significant increases by race/ethnicity were observed overall and by program type, notably for Asians and Hispanics in I-6 programs and Blacks in traditional programs. Finally, of the 1,175 CT surgeons identified, 633 (54%) were adult cardiac surgeons, 360 (37%) assistant professors, 116 (10%) women, and 33 (3%) Black.

CONCLUSIONS

The demographic landscape of CT surgery trainees and faculty across multiple training pathways reflects increasing representation by gender and race/ethnicity. However, we must continue to work toward equitable representation in the workforce to benefit the diverse patients we treat.

Thoracic Surgery Foundation Research Awards: Leading the Way to Excellence

BACKGROUND

Combining clinical and research excellence has become an increasingly difficult endeavor for thoracic surgeons, with typical success rates for the NHLBI and NCI being 25.1% and 11.3% respectively. The Thoracic Surgery Foundation (TSF), which is an arm of the Society of Thoracic Surgeons, provides research awards and grants aimed at early career faculty to assist in securing federal peer reviewed funding. The aim of this study was to assess the impact of these awards.

METHODS

Faculty awardees of the TSF research awards from 1995 to 2019 were included in the study. The scholarly work of awardees was assessed using SCOPUS , MEDLINE, and google scholar for publications, citations and h-index. NIH RePorter and federal RePorter was used to search for any grants awarded to these individuals. For publications and citations associated with a TSF grant, a four-year window from the time of the research award was utilized.

RESULTS

Fifty-two research awards were given to early career faculty during this study period, 8 (15%) were awarded to MD PhDs. Six (12%) of awardees were female. Cardiac faculty were awarded 27 (52%) of awards and general thoracic faculty were awarded 25 (48%); of the cardiac faculty, 4 (17.4%) were congenital cardiac faculty. In the 4-year period following the TSF grant award, the mean number of published articles per awardee was 23 (interquartile range (IQR) 12-36) with a median citation count of 147 (IQR 32-327). The current median h-index was 26 (IQR 15-36) with 2,323 (IQR 1,173-4,568) median citations. Forty-eight percent of all awardees received at least 1 subsequent grant grant, with 40.4% being awarded from the NIH and25% having two or more NIH grants. Comparing academic position at the time of the award to current position, 54% of awardees had an advancement in their professional rank. On analyzing leadership positions, 42% of awardees were division chiefs, 21% were associate clinical directors, and 28% were clinical directors.

CONCLUSIONS

Being a recipient of the TSF award may position an individual to excel in academic medicine, with a large portion of awardees improving their academic standing with time. The rate of successful NIH grant funding after being a TSF awardee is higher than typical institutional success rates.

Trends in Female Authorship: A Bibliometric Analysis of The Annals of Thoracic Surgery

BACKGROUND

Women continue to comprise a small minority of cardiothoracic surgeons. Representation of women in areas of academic achievement has not been well characterized. This study aims to evaluate female representation among authorship positions in high-impact articles published in The Annals of Thoracic Surgery.

METHODS

Altmetric scores were used to identify the top 50 articles published in 2013, 2015, and 2017 in The Annals of Thoracic Surgery. Article characteristics as well as author demographics were collected. Bibliometric analysis was performed to identify longitudinal changes with regard to female representation as first and last authors.

RESULTS

Female authors remain underrepresented in authorship, despite a temporal trend toward improvement in female representation over the years for first author position (16% in 2013, 22% in 2015, 20% in 2017) and last author position (8% in 2013, 16% in 2015, 20% in 2017). Articles authored by women were equally likely to achieve high impact as compared with men, as evaluated by Altmetric score (women 30.1 ± 38.6 vs men 39.1 ± 73.5, P = .53), citations (women 14.3 ± 19.1 vs men 17.6 ± 20.8, P = .45), and to be mentioned by news outlets, blogs, patents, Facebook, Wikipedia, Mendeley, Google, LinkedIn, and Reddit. Female first and last authors achieved comparable numbers of publications and H-index scores compared with male authors.

CONCLUSIONS

Significant sex-based differences in authorship representation persist, but with favorable improvement in female representation over time. Importantly, citations and high-impact status were independent of author sex. Characterization of the representation of women in academic achievement helps us strive for gender equity in our specialty.

A Cross-sectional Review of Cardiothoracic Surgery Department Chairs and Program Directors

OBJECTIVE

Departmental leadership, namely the chair and program director, are sought after positions among academic cardiothoracic surgeons. However, the path to achieving these positions remains unclear. This study sought to characterize the demographics, educational pathways, and career trajectories of current cardiothoracic academic leaders in the United States.

METHODS

A comprehensive list of ACGME accredited thoracic surgery residency and fellowship programs was obtained. Department chairs and program directors were identified for each program from May to June 2019. For each surgeon, demographic data, education, and training institutions were identified. Information was obtained primarily using institutional based websites.

RESULTS

A total of 72 department chairs or division chiefs and 77 program directors were identified. A minority of chairs and program directors were female (4.2%, 10.4%) or had PhD degrees (4.2%, 6.5%). A large number of surgeons trained in the North East region (35%), with Brigham and Women's hospital being the most common training institution (8%). Few chairs (31%) and program directors (39%) hold leadership positions at the institution at which they trained, however a larger proportion (52.8%, 58.4%) remain or return to the same region. Finally, 34.7% of chairs and 32.5% of program directors had some institutional exposure to where they currently practice, through medical school or training.

CONCLUSION

Cardiothoracic department chairs and program directors represent an important group of surgical leaders within our evolving field. As we better understand this group of surgeon-leaders, young trainees and junior faculty that aspire for leadership positions may have a clearer idea of the path to these positions.

A historic event: The first female officer of the American Association for Thoracic Surgery

At the 100th meeting of the AATS, the first woman ever was nominated to be an officer. Dr Yolonda Colson was nominated as Vice President and will be the first female President of the AATS. We celebrate her amazing and inspiring accomplishments.

An Approach to Diversity and Inclusion in Cardiothoracic Surgery

EXECUTIVE SUMMARY

While the United States (US) population at large is rapidly diversifying, cardiothoracic surgery is among the least diverse specialties in terms of racial and gender diversity. Lack of diversity is detrimental to patient care, physician well-being, and the relevance of cardiothoracic surgery on our nation's health. Recent events, including the coronavirus disease 2019 pandemic and the Black Lives Matter protests, have further accentuated the gross inequities that underrepresented minorities face in our country and have reignited conversations on how to address bias and systemic racism within our institutions. The field of cardiothoracic surgery has a responsibility to adopt a culture of diversity and inclusion. This kind of systemic change is daunting and overwhelming. With bias ubiquitously entangled with everyday experiences, it can be difficult to know where to start. The Society of Thoracic Surgeons Workforce on Diversity and Inclusion presents this approach for addressing diversity and inclusion in cardiothoracic surgery. This framework was adapted from a model developed by the National Institute on Minority Health and Health Disparities and includes information and recommendations generated from our literature review on diversity and inclusion. A MEDLINE search was conducted using keywords "diversity," "inclusion," and "surgery," and approaches to diversity and inclusion were drawn from publications in medicine as well as non-healthcare fields. Recommendations were generated and approved by The Society of Thoracic Surgeons Executive Committee. We present an overarching framework that conceptualizes diversity and inclusion efforts in a series of concentric spheres of influence, from the global environment to the cardiothoracic community, institution, and the individual surgeon. This framework organizes the approach to diversity and inclusion, grouping interventions by level while maintaining a broader perspective of how each sphere is interconnected. We include the following key recommendations within the spheres of influence: It is important to note that each of the spheres of influence is interconnected. Interventions to improve diversity must be coordinated across spheres for concerted change. Altogether, this multilevel framework (global environment, cardiothoracic community, institution, and individual) offers an organized approach for cardiothoracic surgery to assess, improve, and sustain progress in diversity and inclusion.

Equal means equal: Cardiothoracic surgery in its second century

OBJECTIVE

As the specialty of cardiothoracic surgery turns the corner into its second century of existence, there has been an uptick in the number of women and underrepresented minorities entering the field, but we have a long way to go before race and gender equity prevails.

METHODS

In this report, specific barriers to diversity without exclusion and mechanisms to breakdown these barriers will be explored.

RESULTS

Barriers to inclusion include a long-standing deficiency in exposure, encouragement, mentorship, and sponsorship to actively attract underrepresented groups to the specialty. Diversity will not occur passively. It will take a concerted effort best employed through a top-down approach at the local and national level, and it has to seem normal.

CONCLUSIONS

Cardiothoracic surgery is an outstanding field for anyone and everyone who seeks a challenging, rewarding career, regardless of their gender, race, or ethnic background. It is the responsibility of leadership to dispel the tradition that certain individuals are not welcome.