The Glaring Gender Bias in the Operating Room: A Qualitative Study of Factors Influencing Career Selection for First-Year Medical Students

Gender bias in surgery: A systematic review of qualitative studies

BACKGROUND

In order to gain a comprehensive understanding of gender bias in the field of surgery, a systematic review was conducted to assess relevant perceptions.

METHODS

We searched PubMed, Embase, and LILACS for qualitative studies on how students, trainees, and surgeons recognize gender aspects concerning surgery. Data was thematically synthesized according to Thomas and Harden's methodology.

RESULTS

Eighteen articles were included, comprising 892 participants, between males and females. Twenty-four codes were generated, and two major themes were identified: gender bias and discrimination, and parenting. Bias were commonly implicit and associated with microaggressions. It involved discouragement, struggles with traditional gender norms, harassment, and lifestyle.

CONCLUSIONS

We highlight the complexity of the barriers towards gender equality in surgery, addressing the lack of representativity and the persistence of bias. Understanding the obstacles and finding ways to overcome them can help to change the current situation.

Reproductive planning and infertility: Training the next generation of surgeons

BACKGROUND

Female surgeons face increased rates of fertility challenges compared to the general population. We aim to understand surgical trainees' understanding and perspectives on family planning.

METHODS

A 35-question survey was emailed to program directors at all US surgical residency programs for distribution to residents. Descriptive analyses were performed to evaluate resident understanding and perspectives on family planning and fertility treatments.

RESULTS

A total of 121 residents responded to the survey. Most were female (n ​= ​78; 65 ​%). Responders indicated the need to postpone pregnancy during training (female: n ​= ​48, 64 ​% vs male n ​= ​18, 45 ​%; p ​= ​0.09). Potential negative career consequences (n ​= ​50; 42 ​%), limited leave benefits (n ​= ​47; 39 ​%), and lack of childcare (n ​= ​45; 38 ​%) were primary reasons for postponing pregnancy. Only nine responders (8 ​%) received fertility-preservation education.

CONCLUSION

Surgical trainees delay pregnancy for career and social support concerns and are interested in reproductive preservation. Fertility education could provide needed support for trainees.

What to expect, when you expect. The neurosurgical perspective

BACKGROUND

Women in neurosurgery often have to delay pregnancy and child-rearing because the optimum time for having children overlap with an intense period of training and/or career advancement. The purpose of the study is to investigate the personal experiences of women neurosurgeons and understand the complex interaction between pursuing a career and embracing motherhood.

METHODS

We employed anonymized, semi-structured interviews with women actively involved in the field of neurosurgery. Person-to-person interviews were performed online via video call. Responses were grouped and analyzed with thematic analysis. We identified recurring patterns and insights in the interview responses.

RESULTS

We included twenty-one women neurosurgeons, at various career levels. Thematic analysis revealed diverse perspectives. More than half favored a delayed pregnancy announcement. The majority perceived a workplace, social stigma attached to pregnancy. Although most of them reported adequate support from their colleagues, several explained that the support was theoretical rather than practical. Many interviewees expressed their fears about losing their surgical skills, while 57.2% had concerns regarding their physical abilities during or after pregnancy. All but one felt that female neurosurgeons should not postpone or sacrifice motherhood for their career. However, alternative paths within neurosurgery could be an option.

CONCLUSIONS

Finding a way to combine a career in neurosurgery with pregnancy can be very challenging and may be vital to keep attracting quality professionals to the field. Efforts should be made to maintain the balance between career and home and to facilitate greater flexibility at the workplace for women who are pregnant and/or child-rearing.

Integrating gender-inclusive initiatives in medical school in Rwanda: Faculty and student experiences at the University of Global Health Equity

PURPOSE

Significant gender disparities exist in the medical field. Medical schools play an important role in promoting gender inclusion, which can lead to increased gender equity in clinical settings. This study explores participants' experiences and gender perspectives at the University of Global Health Equity (UGHE) in Rwanda, which is prioritizing gender inclusion across several initiatives.

MATERIALS AND METHODS

This is a qualitative study with a feminist social constructivist approach. Participants included faculty and students in UGHE's School of Medicine. Participants were selected via random stratified sampling by their role and sex. Twelve semi-structured interviews were conducted, six with faculty and six with students. The data was analyzed via coding and narrative analysis.

RESULTS

Participants described their experiences at UGHE, including strengths, weaknesses, shifts in their own gender perspectives, and recommendations for the future. Three overarching themes included the role of affirmative action, integrating gender-based training and curriculum, and strengthening institutional policies to promote inclusion.

CONCLUSION

Medical schools play a key role in promoting gender equity and catalyzing a shift in gender perspective. Internal systems and policies impact gender inclusion. Medical schools should consider ways to build capacity for both its faculty and students in gender-related topics.

Seeing is Believing - A Qualitative Study Exploring What Motivates Medical Students to Pursue a Career In General Surgery

OBJECTIVE

The personal statement (PS) is a rich text in which medical students introduce themselves to the programs to which they are applying. There is no prompt or agreed upon structure for the personal statement. Therefore it represents a window in to medical students' beliefs and perceptions. The goal of this study was to identify what events or experiences motivate medial students to pursue a career in general surgery. Previous work in this area has been largely survey and interview-based. This study is unique in that it looks at what medical students say when not prompted.

DESIGN

This is a single-institution, retrospective, qualitative review of applicants' PSs. The PSs were coded based on an a priori coding scheme. The coding scheme was based on published literature of why medical students might apply for a general surgery training position.

SETTING

Academic, safety-net hospital.

PARTICIPANTS

The study evaluated a subset of the PSs of applications submitted through the Electronic Residency Application Service (ERAS) for a categorical general surgery position in our program during the 2022 match. Specifically, 308 of all received applications were included in this study. This is the subgroup of applications that was pulled out for a close review based on holistic screening of received applications.

RESULTS

The single most frequently mentioned motivating factor for applying to general surgery training was the experience a student had on the surgery clerkship. The early years of medical school and sub-internships were less frequently identified as motivating experiences. After the overall clerkship experience, the next most frequent motivating factors were that their personality fit well with the culture of surgery and that they realized the important role surgeons played in patient care. 59 applicants wrote about a pre-existing interest in surgery prior to entering medical school. Most frequently this interest developed after witnessing family or friends or applicant themselves have surgery or shadowing a surgeon.

CONCLUSIONS

In this study, students most frequently noted the clerkship experience as having sparked their interest in a career in surgery. Having had exposure to surgeons, through personal experience or shadowing, often led to students to develop an interest in pursuing a career in surgery prior to entering medical school. The findings suggest that to increase the attractiveness of surgery to potential applicants, positive exposure to surgeons and surgery as a field of practice are critical.

Medical Student Perceptions of Family Planning During Residency Training in Surgical Fields

INTRODUCTION

Several studies have investigated surgical residents' perceptions of family planning, and many have investigated medical students' perceptions of surgical specialties; however, there is limited research on medical students' perceptions of the impact of family planning on the decision to pursue surgical training. This study aims to investigate male and female medical students' perceptions of family planning in residency.

METHODS

A survey was distributed to all medical students at a single medical school in the Midwest between February 2023 and June 2023. The survey was adapted from a prior study investigating resident perceptions of family planning. It included questions about parental leave, having children, and perceived barriers to family planning.

RESULTS

One hundred students completed surveys. Seventy-four (74%) respondents identified as female and 57 (57%) were interested in surgery. Approximately half (55, 55%) of the respondents were strongly or definitely considering having children during residency. However, only eight (8%) students were aware of policies applicable to having children during residency. A majority (85, 85%) felt the decision to pursue surgical residency would prevent or delay having children at their preferred time. Most students felt they would be negatively perceived by peers (62, 62%) and faculty (87, 87%) if they had children during training. The highest perceived barriers to having children during training were work-time demands, childcare barriers, and time away from training.

CONCLUSIONS

Both men and women are interested in having children during residency but are unaware of the relevant parental leave policies and are concerned about how training will be impacted by taking time away or a lack of flexibility. Without transparency and flexibility in surgical residency, both men and women may forgo having children during training or choose a specialty they perceive to be more conducive to childbearing.

Factors Influencing Underrepresented Medical Students' Career Choice in Surgical Subspecialties

OBJECTIVES

Surgical subspecialties rank among the least racially and gender diverse of the medical specialties. The purpose of this systematic review is to evaluate the current factors that influence female, gender and sexual minority (GSM), and underrepresented in medicine (URiM)-identifying medical students' decision to pursue a career in a surgical subspecialty.

DATA SOURCES

A structured literature search of PubMed, Scopus, Web of Science, and Medline was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Criteria for eligibility included surveys and interviews assessing factors and barriers influencing underrepresented medical students' career choices.

REVIEW METHODS

Two independent researchers screened the articles' titles and abstracts for relevance; three performed full-text reviews.

RESULTS

Of 343 studies identified, 17 met the inclusion criteria. Fourteen (82%) were survey-based studies; three (18%) were qualitative interviews. Represented minorities included females (14), URiM (13), and GSM (4). Female medical students were most influenced by (1) exposure to surgery, (2) mentorship, and (3) surgical lifestyle. URiM medical students were most influenced by (1) mentorship, (2) culture and diversity, (3) research opportunities, and (4) personality fit. GSM medical students were most influenced by identity acceptance and instances of discrimination and bias.

CONCLUSIONS

Our review provides granular data on positive and negative factors influencing career choice among underrepresented medical students to facilitate the development of a more diverse surgical workforce. Female medical students were more positively influenced by increased exposure to surgical subspecialties, whereas URiM medical students were more positively influenced by race-concordant mentorship. Laryngoscope, 134:1498-1506, 2024.

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

BACKGROUND

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

HYPOTHESIS

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

METHODS

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

RESULTS

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

CONCLUSION

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

Greater Risk of Pregnancy Complications for Female Surgeons: A Cross-Sectional Electronic Survey

BACKGROUND

Female surgeons are exposed to physical and mental stressors that differ from those of other specialties. We aimed to assess whether female surgeons are more at risk of pregnancy complications than women in other medical specialties.

METHODS

We used a cross-sectional electronic survey of female physicians working in the French Region Nouvelle-Aquitaine who were pregnant between 2013 and 2018. A pregnancy complication was defined as the occurrence of miscarriage, ectopic pregnancy, fetal growth restriction, prematurity, fetal congenital malformation, stillbirth, or medical termination of the pregnancy. Multivariate logistic regression models were used to evaluate the risk of pregnancy complications for female surgeons relative to women practicing in other medical specialties.

RESULTS

Among the 270 women included, 52 (19.3%) experienced pregnancy complications and 28 (10.4%) were surgeons. In the multivariate analysis, female surgeons had a higher risk of pregnancy complications: adjusted odds ratio = 3.53, 95% confidence interval [1.27-9.84].

CONCLUSION

Further research is necessary to identify the hazards specifically involved in the practice of surgery to be able to propose preventive actions targeted to female surgeons during their pregnancy.

The job market for HPB surgeons: leadership perspectives on surgeon skillsets, training pathways, and hiring

BACKGROUND

Three tracks prepare Hepato-Pancreato-Biliary (HPB) surgeons: HPB, surgical oncology, and transplant fellowships. This study explored how surgical leaders thought about HPB surgery and evaluated potential candidates for HPB positions.

METHODS

This descriptive qualitative study utilized interviews of healthcare leaders whose responsibilities included hiring HPB surgeons. We coded inductively then used thematic network analysis to organize the data. Individual codes formed basic themes, then larger secondary themes, then finally "primary" themes.

RESULTS

Primary themes were: (1) What defines an HPB surgical practice?, (2) How do they assess candidates for HPB positions?, and (3) How will HPB practices continue to evolve? Leaders assessed applicants' training, behaviors and cultural fit, technical excellence, and more. Personal recommendations and professional networks significantly influenced the hiring process. HPB surgery needs were growing due to population changes, treatments advances, and changing market conditions.

DISCUSSION

Surgical societies should focus on facilitating networking, promoting transparency, sharing quality data, providing evidence of technical skills and teamwork, mentorship, and providing guidance to general surgery residency program directors. There is great interest in unification and cooperation across the profession, protocol standardization enhancing quality, continued workforce diversification, and evaluation of the alignment between training and practice.

Ophthalmology Education Leadership Attitudes Towards Mentorship of Female Medical Students

PURPOSE

Numerous studies have emphasized the influence of gender-specific mentors in medical students' career decisions, but this has not been explored fully in ophthalmology. Therefore, this study evaluated ophthalmology educators' attitudes towards female mentorship, to better understand how this may relate to medical students' career development and training.

DESIGN

Cross-sectional study.

METHODS

A 22-question survey was sent to AUPO Chairs, Program Directors, and Medical Student Educators. The number of female students applying to ophthalmology residency was compared with the number of female ophthalmology faculty using AUPO and AAMC workforce data. Student's t-tests and chi square were used for analyses, all at a threshold significance level of p<0.05.

RESULTS

75 members responded, including 30 of 72 MSEs (41.7%), 34 of 114 PDs (29.8%), and 17 of 135 Chairs (12.6%). Of respondents, 55.4% identified as female and 44.6% as male. Male and female members had 47.9% and 47.6% female mentees, respectively, (p=0.45). However, 21.2% of male and 56.1% of female members agreed that a mentee of the same gender was important, (p<0.01). Furthermore, 13 of 40 female members (32.5%) reported having a significant female mentor themselves vs. 1 of 29 male members (3%), (p<0.01).

CONCLUSIONS

Male and female AUPO members reported no difference in female mentees but females were more likely to feel gender-specific mentorship was important, suggesting room for further development of this resource. Expansion of female mentorship in ophthalmology can promote equity in training and help address the lack of female representation in leadership.

Artificial Intelligence and Surgical Education: A Systematic Scoping Review of Interventions

OBJECTIVE

To synthesize peer-reviewed evidence related to the use of artificial intelligence (AI) in surgical education DESIGN: We conducted and reported a scoping review according to the standards outlined in the Preferred Reporting Items for Systematic Reviews and Meta-Analysis with extension for Scoping Reviews guideline and the fourth edition of the Joanna Briggs Institute Reviewer's Manual. We systematically searched eight interdisciplinary databases including MEDLINE-Ovid, ERIC, EMBASE, CINAHL, Web of Science: Core Collection, Compendex, Scopus, and IEEE Xplore. Databases were searched from inception until the date of search on April 13, 2021.

SETTING/PARTICIPANTS

We only examined original, peer-reviewed interventional studies that self-described as AI interventions, focused on medical education, and were relevant to surgical trainees (defined as medical or dental students, postgraduate residents, or surgical fellows) within the title and abstract (see Table 2). Animal, cadaveric, and in vivo studies were not eligible for inclusion.

RESULTS

After systematically searching eight databases and 4255 citations, our scoping review identified 49 studies relevant to artificial intelligence in surgical education. We found diverse interventions related to the evaluation of surgical competency, personalization of surgical education, and improvement of surgical education materials across surgical specialties. Many studies used existing surgical education materials, such as the Objective Structured Assessment of Technical Skills framework or the JHU-ISI Gesture and Skill Assessment Working Set database. Though most studies did not provide outcomes related to the implementation in medical schools (such as cost-effective analyses or trainee feedback), there are numerous promising interventions. In particular, many studies noted high accuracy in the objective characterization of surgical skill sets. These interventions could be further used to identify at-risk surgical trainees or evaluate teaching methods.

CONCLUSIONS

There are promising applications for AI in surgical education, particularly for the assessment of surgical competencies, though further evidence is needed regarding implementation and applicability.

Gender bias in reference letters for residency and academic medicine: a systematic review

Reference letters play an important role for both postgraduate residency applications and medical faculty hiring processes. This study seeks to characterise the ways in which gender bias may manifest in the language of reference letters in academic medicine. In particular, we conducted a systematic review in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We searched Embase, MEDLINE and PsycINFO from database inception to July 2020 for original studies that assessed gendered language in medical reference letters for residency applications and medical faculty hiring. A total of 16 studies, involving 12 738 letters of recommendation written for 7074 applicants, were included. A total of 32% of applicants were women. There were significant differences in how women were described in reference letters. A total of 64% (7/11) studies found a significant difference in gendered adjectives between men and women. Among the 7 studies, a total of 86% (6/7) noted that women applicants were more likely to be described using communal adjectives, such as "delightful" or "compassionate", while men applicants were more likely to be described using agentic adjectives, such as "leader" or "exceptional". Several studies noted that reference letters for women applicants had more frequent use of doubt raisers and mentions of applicant personal life and/or physical appearance. Only one study assessed the outcome of gendered language on application success, noting a higher residency match rate for men applicants. Reference letters within medicine and medical education exhibit language discrepancies between men and women applicants, which may contribute to gender bias against women in medicine.