Career barriers for women in surgery

Association of Residency Applicant Sociodemographic Characteristics With Specialty Choice and Interview Outcomes

OBJECTIVE

To evaluate associations of residency applicant sociodemographic characteristics with specialty choice, academic metrics, and application outcomes. Academic metrics included clerkship honors, honor society membership, United States Medical Licensing Exam (USMLE) scores, degree type (allopathic or osteopathic), second degrees or research year, required remediation, couples match, research output, and volunteer or leadership positions.

DESIGN

Retrospective, cross-sectional analysis of applicants who responded to the Texas Seeking Transparency in Application to Residency (STAR) survey.

SETTING

National survey of medical students in the United States.

PARTICIPANTS

Medical students in the United States participating in the 2021 to 2022 and 2022 to 2023 residency application cycles.

RESULTS

Among 10,856 applicants during the 2022 and 2023 match years, 1,687 (15.5%) identified as Underrepresented in Medicine (URiM), 1642 (15.1%) were the first generation to attend college, 931 (8.6%) reported a history of food or housing insecurity, and 6104 (56.2%) identified as female. All of these groups were significantly less likely to apply to surgical subspecialties (OR 0.76, p < 0.001; OR 0.81, p = 0.009; OR 0.81, p = 0.041; OR 0.41, p < 0.001, respectively). When adjusting for academic metrics, this association persisted for female applicants (OR 0.58, p < 0.001), and it was the inverse for URiM applicants (OR 1.28, p = 0.016). Applicants with a history of food or housing insecurity had a lower match rate (73.3% vs. 83.4%; p = 0.008) than those without. Interview and match outcomes were noninferior among the other sociodemographic groups historically underrepresented in surgery.

CONCLUSION

Underrepresentation, already pervasive in medicine, is amplified in surgical subspecialties, underscoring the need for applying an equity lens across the continuum of medical education.

Led by vascular surgery, vascular interventions are increasingly performed by women

OBJECTIVE

Historically, the medical profession is a male-dominated field. Although the number of women entering surgical specialties is rising, this increase is not proportionate to the composition of medical school graduates, which are now 50% female. This study aimed to investigate the specialty and gender of practitioners performing common vascular procedures.

METHODS

Medical claims data was obtained from the Centers for Medicare and Medicaid Services. Claims were linked to provider characteristics in the National Plan and Provider Enumeration System using the national physician identifier. The study included final billing records from inpatient claims from 2017 to 2021. Procedures of interest were identified by the primary International Classification of Disease-10 Procedure Coding System codes. Provider taxonomy, gender, tenure, and region were derived from National Plan and Provider Enumeration System using their national physician identifier.

RESULTS

Among all specialties, board-certified vascular surgeons performed the highest percentage of open infrarenal aortic interventions (68.6%), endovascular aorta repairs (65.2%), carotid endarterectomies (59.1%), endovascular carotid interventions (32.4%), open arteriovenous fistulas (AVFs; 60.3%), endovascular AVFs (59.3%), open infrainguinal interventions (71.4%), and endovascular infrainguinal interventions (45.7%). For the two categories where vascular surgeons performed less than one-half of the procedures, the next most common specialties were neurology/neurosurgery (17.9%) and interventional cardiology (10.8%) for endovascular carotid interventions and interventional cardiology (11.1%) and interventional radiology (10.3%) for endovascular infrainguinal interventions. Over the 5-year period, the percentage of procedures performed by vascular surgeons increased for all categories except endovascular AVFs. Analyzing by gender, the majority of all procedures were performed by male physicians, which ranged from 88.3% (endovascular AVFs) to 94.7% (endovascular carotid intervention). Over the 5-year interval, however, all specialties had a significant increase in the percentage of vascular procedures performed by females (P < .05) except thoracic/cardiac surgery. Among all specialties, vascular surgery had the greatest absolute increase in female-performed interventions (P < .05).

CONCLUSIONS

Although the majority of vascular interventions are still performed by male practitioners, the proportion of procedures conducted by females is increasing. Among all specialties, vascular surgery has both the highest proportion and greatest absolute increase of vascular procedures performed by women. Future recruitment efforts should focus on continuing to reduce this disparity.

Progress With Shortcomings: An Examination of Demographic Representation in Integrated Plastic Surgery Residencies

BACKGROUND

This retrospective study investigates progress in representation among Black, Hispanic, American Indian/Alaska Native (AIAN) Native Hawaiian/Pacific Islander (NHPI), and female demographics in plastic surgery and other surgical residencies. Utilizing applicant and resident data, demographic trends were examined to assess the effectiveness of recent diversification efforts.

METHODS

Binomial analysis of proportions applicants and residents between 2016 and 2022 was conducted. Instances where proportions of applicants surpassed that of residents indicated underrepresentation. Representation trends were assessed via linear regressions of proportions of applicants and residents with time as the explanatory variable. Binomial analysis of proportions of medical school graduates in 2020 and plastic surgery residents in 2021 was conducted. Instances where proportions of graduates surpassed that of residents indicated underrepresentation.

RESULTS

Plastic surgery saw an increase in female applicants (14.9%) and residents (5.5%), an increase in Hispanic residents from 2020-2022 (1.3%), and a decrease in AIAN (0.4%) and NHPI residents (0.2%). Black residents remained the most underrepresented group of residents relative to applicants. Trends were similar to those seen in other specialties. All groups were underrepresented in plastic surgery relative to numbers in the US population and among medical school graduates.

CONCLUSIONS

Findings suggest that plastic surgery has made minimal progress in achieving representativeness relative to the US population. Although women and Hispanic demographics have made strides, similar progress has not been evident among Black, AIAN, and NHPI demographics. All groups continue to experience varying degrees of underrepresentation across specialties. Addressing this persistent disparity demands further investigation and targeted, strategic interventions.

Gender Research Gap in Orthopaedics and Trauma Surgery: Gender-specific Disparities in Submission of Abstracts to the German Congress of Orthopaedic and Trauma Surgery from 2015 to 2024

Gender-specific differences also affect the subject of orthopaedics and trauma surgery (O&T). While the proportion of women studying medicine is steadily increasing, the proportion of female surgeons in O&T is only 18.6%. This underrepresentation affects not only clinics but also research and is reflected in participation in scientific annual meetings such as the German Congress for Orthopaedics and Trauma Surgery (DKOU).This retrospective study examined the gender differences in abstract submissions to the DKOU from 2015 to 2024. The anonymised data were subjected to examination regarding gender, role in submission and academic title.The overall participation of women in the 82,813 abstracts was 20%. The proportion of women among submitters was 23.3%, among presenters 24.5% and among co-authors 18.2%. In the analysis of the female cohort alone, women were more likely to be submitters and presenters than in the male cohort (p < 0.001). The proportion of female participation in abstract submissions increased by an average of 0.5% per year over the study period. However, women were significantly underrepresented at higher academic degrees, such as habilitations (7.4%), professorships (7.6%) and university professorships (5.2%).The results show that the proportion of women submitting abstracts to the DKOU largely corresponds to the percentage in the field of orthopaedics and trauma surgery (18.6% in 2022), reflecting the overall gender disparity in this specialty. If this trend analysis were applied to the general development of gender parity in orthopaedics and trauma surgery, gender-equitable staffing of medical positions could not be achieved before the year 2087. To accelerate this development, targeted measures to promote women in orthopaedics and trauma surgery are necessary. This includes dismantling structural barriers and implementing specific support programs for female surgeons pursuing academic careers.

Childbearing and Pregnancy Trends Among Female Plastic and Orthopedic/Trauma Surgeons in German-speaking Countries

Background

Female surgeons face challenges when trying to balance family planning and surgical duties. Although US surgeons have been thoroughly investigated in terms of obstetric complications and perception toward pregnancy, information on surgeons in German-speaking countries is lacking.

Methods

A multicentric online survey was conducted to analyze female plastic and orthopedic/trauma surgeons from Germany, and plastic surgeons from Switzerland and Austria.

Results

Mean age during first pregnancy was 33 years. More than one-third of all surgeons intentionally postponed pregnancy for professional reasons. About one-third of the German surgeons was banned from clinical work during pregnancy, whereas 6% of all Swiss/Austrian surgeons were banned. Accordingly, the Swiss/Austrian surgeons were operating more often during pregnancy. Obstetric complications ranged from 41% to 58%. The Swiss/Austrian plastic surgeons had the lowest complication rate. The rate of cervical insufficiency was approximately 4%, which was higher than in the general and US surgeons' population, whereas fertility issues and miscarriage were lower in German-speaking plastic surgeons.

Conclusions

Despite national maternity protection laws, obstetric complication rates of surgeons in German-speaking countries and the United States were similar. Cervical insufficiency was even more prevalent in the study population, which could be associated with an older age of the expectants. Therefore, those (strict) laws need to be reconsidered because a ban from surgery can lead to intentional postponement of pregnancy.

The association between gender and industry payments to minimally invasive surgeons

BACKGROUND

It is unknown if there are differential industry payments to surgeons based on gender. This study aims to examine differences by gender for industry relations with minimally invasive surgeons, using speakers at the SAGES Annual Meeting as a proxy for key thought leaders in minimally invasive surgery.

METHODS

We queried the Open Payments Database for payments made to US speakers from the 2023 SAGES meeting. All payments from the prior fiscal year prior were collected. The National Provider Identity (NPI) Registry was cross-referenced to determine surgeon's self-reported gender. Industry sponsors were analyzed based on differences in payments made.

RESULTS

A total of 305 speakers were assessed, with 175 (57.4%) males and 130 (42.6%) females. Of the 305 speakers, 246 were listed in the OPD. There were 145/175 (82.8%) males who were received general payments, compared to 101/130 (77.6%) females (p = 0.326). The total amount of industry payments was $2,894,287 for males and $1,539,481 for females. Median payments were 2.8X higher for males ($4657, IQR $422-$15,798) than females ($1651, IQR $299-$9005) (p = 0.05).

CONCLUSIONS

Despite efforts to decrease gender bias in surgery, there remains a significant and substantial difference in payments towards male and female surgeons via industry relationships. This has potential downstream effects on career development, consulting and research opportunities, and development of new devices.

Gender Parity Among Vascular Surgeons: Progress and Attrition

INTRODUCTION

Improving representation of women in medicine and surgery has been tempered by higher rates of attrition from residencies and from academic medicine among women compared to men. The attrition of women from the practicing vascular surgery workforce has not been studied.

METHODS

We utilized the Center for Medicare and Medicaid Services' Doctors and Clinicians database to study vascular surgery employment patterns from 2015 to 2022. We examined gender balance within the workforce and attrition rates among male and female vascular surgeons. We utilized a logistic regression to calculate the odds of attrition by gender.

RESULTS

The percentage of female vascular surgeons grew from 11% to 16% between 2015 and 2022, with each graduating class since 2005 having between 20% and 38% women. Yet, female surgeons were 2.05 (95% confidence interval: 1.36-3.08) times more likely to leave practice than their male counterparts when controlling for graduation year and practice in academic medicine.

CONCLUSIONS

The proportion of women in vascular surgery is increasing as more women graduate into the specialty. Despite increasing representation, women are more likely than men to leave the workforce.

Exploring Diversity in North American Academic Pediatric Otolaryngology

OBJECTIVE

Representation of women and minority groups is traditionally low in Otolaryngology-Head & Neck Surgery (OHNS). This cross-sectional study aims to assess the difference in gender and racial/ethnic representation within Academic North American pediatric OHNS.

STUDY DESIGN

Cross-sectional study of North American pediatric OHNS faculty websites.

SETTING

North America.

METHODS

Canadian and American residency program registries were searched for accredited OHNS programs. Pediatric OHNS faculty were identified through program websites. Information regarding gender, race/ethnicity, time in practice, research productivity, academic title, and leadership positions was extracted from public profiles and Scopus. Demographic and academic data was also extracted for OHNS and pediatric OHNS department/division chairs.

RESULTS

North American academic pediatric OHNS websites listed 516 surgeons, of whom 39.9% were women. Most surgeons were perceived as White (69.0%), followed by Asian (24.0%), Hispanic (3.7%), and Black (3.3%). Women surgeons had lower h-indices, less publications, and less citations than men (P < .001). Despite women surgeons having fewer years in practice (median 8.0 vs 13.0, P < .001), gender-differences in h-index persisted when controlling for years in practice (P < .05). Men surgeons had higher academic titles (P < .001), but there was no gender difference in leadership roles while accounting for years in practice (P = .559). White surgeons had higher academic titles than non-White surgeons (P = .018). There was no racial/ethnic difference in leadership roles (P = .392).

CONCLUSION

Most pediatric OHNS surgeons are men and/or White. Significant gender-differences in research productivity and academic title exist, however surgeons of racial/ethnic minority have similar research productivity as their racial/ethnic majority counterparts.

[Gender-Specific and Cross-Gender Reasons for Choosing 'Surgeon' as a Career - A Scoping Review]

INTRODUCTION

The availability of highly qualified surgical staff in Germany has been a challenge for years. Despite various initiatives to increase the attractiveness of surgical training programs, there are still problems in attracting motivated and qualified doctors to surgery. In order to develop customized offers for recruiting junior staff, the decision-making factors must be known.

OBJECTIVE

To present the gender-specific and cross-gender reasons for choosing a surgical specialist training program.

METHOD

As part of a scoping review, studies were identified using PubMed and a subsequent reverse search to answer the research question. Data extracted from the studies were summarized narratively and categories were defined.

RESULTS

The analysis of 12 studies revealed that men and women wanted to become a surgeon based on the characteristics of the surgical specialty, personal factors and factors related to the training position. Gender-specific differences were also identified.

CONCLUSION

Specific measures are proposed to promote the next generation of surgeons.

Quantification of training in educational methodology among teachers on the degree course in medicine: a pilot study

BACKGROUND

Medical education has undergone significant changes over the last decades. Scientific and technological progress alongside contemporary society's changing requirements have driven demand for highly trained, competent doctors. In response to this need, university faculties of medicine have sought innovative forms of teaching and evaluating the students on their degree courses. The aim of this study was to quantify the characteristics and extent of academic training in teaching methods, of participation in innovative teaching initiatives, and training in simulation and debriefing among the teaching personnel on the degree course in medicine at the University of Granada (Spain).

METHODS

This transversal descriptive study was conducted among a population of 121 educators teaching on the medical degree course at the University of Granada, Spain. All responded to a specially designed CoRe-Content Representation questionnaire. This consisted of various parts: (a) demographic data; (b) teaching experience and qualifications; (c) specific information about training in teaching skills received. The Fisher test was applied whenever the dependent variable had two values (dichotomous) and the Chi-square test when it had more than two values (polytomic). Statistical significance was established with an alpha error of 5%.

RESULTS

The results showed that 87.60% of the educators had received no training in debriefing. There was a notable gender gap, whereby women held fewer management posts, fewer were engaged in clinical activity, and fewer had undergone training in clinical simulation. Teachers with degrees in medicine had undergone less regulated training than educators with other degree qualifications.

CONCLUSION

The main areas of medical training that require improvement (and so present challenges to be met in the years to come) are as follows: a definitive solution to the existing gender gap, general implementation of new educational models and methods (especially learning based on clinical problem-solving and simulation), closing generation gaps, and improved training processes for educators with clinical attachment.

Textbook Outcome in Colorectal Surgery for Cancer: An Italian Version

Background/Objectives: The textbook outcome (TO) is a composite tool introduced to uniform surgical units and regulate surgical quality and outcomes. A patient is considered TO only if all predetermined items are met. In colorectal surgery, TO represents a new tool that can achieve important results given the prevalence of colorectal cancers. However, at present, there is a lack of uniformity in the TO's definition. This study utilized the Delphi process to define an Italian version of the TO in colorectal cancer. Methods: The survey consisted of two rounds of online questionnaires submitted to an expert panel in colorectal oncological surgery, renowned academic surgeons, who had attended multiple scientific conferences and who were authors of papers on this specific topic. Five main topics with 26 questions were investigated through an online modified Delphi method. Items with almost 75% agreement achieved consensus. Results: Twenty-eight Italian experts were selected and participated in the two rounds. The Italian version of the textbook outcome in colorectal surgery was defined as the presence of 90-day postoperative survival, negative margins and at least 12 lymph nodes, a minimally invasive approach, ostomy fashioning if preoperatively planned, postoperative complication < Clavien-Dindo 3b, at least 10 ERAS items, no readmission, proper CHT and RT regimens, complete colonoscopy after or before surgery and Tumor Board Evaluation. Conclusions: The textbook outcome in colorectal cancer patients is a quality instrument providing a complete overview of the care of such patients, from diagnosis to treatment. We hereby propose an Italian version of the TO with outcomes chosen by an expert panel.

Inspiring and Preparing Our Future Leaders: Evaluating the Impact of the Early Career Women's Leadership Program

Purpose

The number of women in high-level leadership in academic medicine remains disproportionately low. Early career programs may help increase women's representation in leadership. We evaluated the Early Career Women's Leadership Program (ECWLP). We hypothesized that participants would rate themselves as having increased confidence in their leadership potential, improved leadership skills, and greater alignment between their goals for well-being and leading after the program. We also explored the participants' aspirations and confidence around pursuing high-level leadership before and after the program.

Methods

We surveyed women physicians and scientists before and after they participated in the 2023 ECWLP, consisting of 11 seminars over six months. We analyzed pre- and post-program data using Wilcoxon signed-rank tests. We analyzed answers to open-ended questions with a content analysis approach.

Results

47/51 (92%) participants responded, and 74% answered pre- and post-program questionnaires. Several metrics increased after the program, including women's confidence in their ability to lead (p<0.001), negotiate (p<0.001), articulate their career vision (p<0.001), reframe obstacles (p<0.001), challenge their assumptions (p<0.001), and align their personal and professional values (p=0.002). Perceptions of conflict between aspiring to lead and having family responsibilities (p=0.003) and achieving physical well-being (p=0.002) decreased. Perceived barriers to advancement included not being part of influential networks, a lack of transparency in leadership, and a competitive and individualistic culture. In the qualitative analysis, women described balancing internal factors such as self-doubt with external factors like competing professional demands when considering leadership. Many believed that becoming a leader would be detrimental to their well-being. Beneficial ECWLP components included support for self-reflection, tactical planning to pursue leadership, and creating a safe environment.

Conclusion

The ECWLP improved women's confidence and strategic plans to pursue leadership in a way that supported their work-life integration. Early career leadership programs may encourage and prepare women for high-level leadership.

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Characterizing gender trends in head and neck fellowship graduates from 2008 to 2018

OBJECTIVES

Evaluation of potential gender gaps among Head and Neck (H&N) surgeons can highlight areas for increased support of female H&N surgeons and improve gender diversity within the subspecialty. To evaluate gender trends in representation and career trajectory among recent H&N surgery fellowship graduates.

METHODS

This cross-sectional analysis included graduates from Head and Neck Surgery fellowships accredited by the American Head and Neck Society (AHNS) from 2008 to 2018. Additional demographic data was collected via publicly available websites including gender, years in practice, practice location, type of practice, h-index, and academic rank. The primary outcomes were the proportion of female Head and Neck fellowship graduates and gender trends in career trajectory and academic productivity (via h-index).

RESULTS

Between 2008 and 2018, 449 surgeons graduated from Head and Neck surgery fellowship with females comprising 99 of 449 graduates (22%). Female representation increased from 1 of 30 (3%) graduates in 2008 to 17 of 52 (33%) in 2018. A proportionally similar number of women graduating fellowship also practiced in an academic setting (23%). There were fewer female assistant, associate and full professors compared with their male counterparts. Women had lower h-indices compared with men even when controlling for years in practice (mean 11.4 vs. 8.2, p < 0.03).

CONCLUSION

Despite the increase in women graduating from H&N surgery fellowships, gender disparities within academic rank and academic productivity as measured by h-index remain. While a proportional number of women completing fellowship are entering academic practice, additional investigation and support is needed to address the potential gender gaps identified within academic H&N surgery.

Women in surgery: do surgical specialties keep up with the feminization of medicine in Brazil?

INTRODUCTION

historically, surgical medical specialties are mostly male, a scenario which, in recent years, has undergone changes. In this sense, despite the relevance of the growth of female participation in the medical career, little is discussed about the distribution between genders of the main surgical medical specialties in the country.

OBJECTIVE

discuss the process of feminization in surgical specialties in Brazil over the last few years, tracing a distribution profile of these specialties.

METHODS

this is a retrospective and cross-sectional study with secondary data from the Censuses of Medical Demography in Brazil in the years 2011, 2013, 2015, 2018, 2020 and 2023, including the surgical specialties: Urology, Orthopedics and Traumatology, Thoracic Surgery, Neurosurgery, Digestive System Surgery, Cardiovascular Surgery, Hand Surgery, General Surgery, Head and Neck Surgery, Vascular Surgery, Plastic Surgery, Ophthalmology, Coloproctology, Otorhinolaryngology, Pediatric Surgery, and Gynecology and Obstetrics.

RESULTS

males prevails in numbers, among the surgical specialties, however, with a lower growth rate compared to females. Specialties such as urology, orthopedics and traumatology and neurosurgery are mostly male, while gynecology and obstetrics are female.

CONCLUSION

it is evident that female participation in the surgical medical field has increased significantly over the last few years.

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

PURPOSE

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

LEVEL OF EVIDENCE

IV.

The state of female hepato-pancreato-biliary (HPB) surgeons in China: see us in operation theater with great prospects

OBJECTIVE

This study aims to investigate the proportion and distribution of female HPB surgeons in China, describe their current status, and analyze the possible barriers and challenges in their careers.

METHOD

Tertiary hospitals with the division of HPB in mainland China in 2021 were enrolled and surgeon demographic information was collected through the review of official websites and/or telephone interviews.

RESULTS

The majority of female HPB surgeons (72.92%) were located in the first or second-tier cities in mainland China, with an increasing number of new female HPB surgeons entering the field annually, particularly after 2005 (from 27 to 52 per 5 years). Despite no significant difference in academic backgrounds, female HPB surgeons initiated their careers at an earlier age and took a longer time to obtain chief titles (P < 0.05). Interestingly, female HPB surgeons performed laparoscopic complex HPB cases at a similar rate (95.42%) to their male counterparts and were more likely to specialize in endoscopic surgery (P = 0.021), with a similar ratio of obtaining administrative positions.

CONCLUSION

Minimally invasive surgery may provide females with unprecedented opportunities in the HPB surgery field. However, despite the increasing numbers of female HPB surgeons, the proportion remains low in China.

Gender associations with selection into Australian General Surgical Training: 2016-2022

BACKGROUND

For those who have maintained an interest in general surgery after medical school and their early post-graduate years, selection is the first step to a career in general surgery. Identifying differences secondary to gender in selection tools and their outcomes should assist the Royal Australasian College of Surgeons and the Australian Board in General Surgery to improve gender equity in the general surgical workforce. Selection tools for general surgery include the curriculum vitae (CV), referee report (RR) and multiple mini-interview (MMI).

METHODS

All applicants' CV, RR and MMI scores achieved in the general surgery selection process were reviewed by gender over a seven-year period.

RESULTS

In all years, there were lower numbers of female applicants to selection. There were differences identified between genders in the CV and MMI, with females scoring lower in the CV and higher in the MMI when compared to males. There were no differences identified in the RR or proportion of applicants that were successful in their application based on gender.

CONCLUSION

The CV and MMI utilized for selection into general surgery were associated with gender bias. However, the lower number of females selected into training reflects the lower number of female applicants overall. There was no overall impact from gender found in an applicant's ability to be selected into general surgery in Australia.

The subjective career success of women: The role of personal resources

Introduction

Research on women’s career success has been the subject of extensive investigations, emphasizing the barriers they encounter in their careers. However, far less attention has been given to the personal resources that promote women’s career success. The purpose of our study was to provide more conclusive evidence regarding the role that personal resources such as resilience and grit can play in the relationship between women’s person-environment fit and the perceptions of their career success. Underpinned by the Job Demands Resources and social cognitive theory, our study aims to investigate whether resilience and grit could either explain how person-environment fit translates into feelings of subjective career success or could strengthen this relationship.

Method

A cross-sectional online survey research design was used, and a convenience sample of 408 female employees was obtained. Relationships were explored through structural equation modelling.

Results

When controlling for age, the findings of this study revealed significantly positive relationships between the constructs, with person-environment fit, resilience, and grit, explaining a large portion of the variance in subjective career success. Although our data supported the mediating role of grit and resilience in the person-environment fit and subjective career success relationship, the moderating effects of grit and resilience could not be established.

Discussion

These findings illustrate both grit and resilience as mechanisms that indirectly affect the person-environment fit and subjective career success relationship of women. However, our findings indicate that resilience and grit cannot be considered mechanisms that would buffer against poor person-environment fit’s effect on their career success perceptions. Firstly, our study advances our understanding of the roles personal resources such as resilience and grit play in women’s career success as ways to overcome obstacles and workplace barriers. Secondly, using the motivational process of the Job Demands Resources Framework as theoretical background, we contribute by shedding light on how personal resources (resilience and grit) can be considered underlying factors influencing the person-environment fit and career success relationship for women. If women experience good person-environment fit, there is a greater opportunity for developing resilience and grit and, consequently, subjective career success.

Donor, Recipient and Surgeon Sex and Sex-Concordance and their Impact on Liver Transplant Outcome

(1) Background: Patient sex is associated with differential outcome of many procedures although the exact mechanisms remain unknown. Especially in transplant surgery, surgeon-patient sex-concordance is rarely present for female patients and outcome may be negatively affected. (2) Methods: In this single-center retrospective cohort study, recipient, donor, and surgeon sex were evaluated and short- and long-term outcome was analyzed with regards to sex and sex-concordance of patients, donors, and surgeons. (3) Results: We included 425 recipients in our study; 50.1% of organ donors, 32.7% of recipients, and 13.9% of surgeons were female. Recipient-donor sex concordance was present in 82.7% of female recipients and in 65.7% of male recipients (p = 0.0002). Recipient-surgeon sex concordance was present in 11.5% of female recipients and in 85.0% of male recipients (p < 0.0001). Five-year patient survival was comparable between female and male recipients (70.0% vs. 73.3%, p = 0.3978). Five-year patient survival of female recipients treated by female surgeons was improved without reaching significance (81.3% vs. 68.4%, p = 0.3621). (4) Conclusions: Female recipients and female surgeons are underrepresented in liver transplant surgery. Societal factors influencing outcome of female patients suffering from end-stage organ failure need to be further examined and acted upon to possibly improve the outcome of female liver transplant recipients.

Comparison of Male and Female Surgeons' Experiences With Gender Across 5 Qualitative/Quantitative Domains

Importance

A growing body of literature has been developed with the goal of attempting to understand the experiences of female surgeons. While it has helped to address inequities and promote important programmatic improvements, work remains to be done.

Objective

To explore how practicing male and female surgeons' experiences with gender compare across 5 qualitative/quantitative domains: career aspirations, gender-based discrimination, mentor-mentee relationships, perceived barriers, and recommendations for change.

Design, Setting, and Participants

This national concurrent mixed-methods survey of Fellows of the American College of Surgeons (FACS) compared differences between male and female FACS. Differences between female FACS and female members of the Association of Women Surgeons (AWS) were also explored. A randomly selected 3:1 sample of US-based male and female FACS was surveyed between January and June 2020. Female AWS members were surveyed in May 2020.

Exposure

Self-reported gender.

Main Outcomes and Measures

Self-reported experiences with career aspirations (quantitative), gender-based discrimination (quantitative), mentor-mentee relationships (quantitative), perceived barriers (qualitative), and recommendations for change (qualitative).

Results

A total of 2860 male FACS (response rate: 38.1% [2860 of 7500]) and 1070 female FACS (response rate: 42.8% [1070 of 2500]) were included, in addition to 536 female AWS members. Demographic characteristics were similar between randomly selected male and female FACS, with the notable exception that female FACS were less likely to be married (720 [67.3%] vs 2561 [89.5%]; nonresponse-weighted P < .001) and have children (660 [61.7%] vs 2600 [90.9%]; P < .001). Compared with female FACS, female AWS members were more likely to be younger and hold additional graduate degrees (320 [59.7%] were married; 238 [44.4%] had children). FACS of both genders acknowledged positive and negative aspects of dealing with gender in a professional setting, including shared experiences of gender-based harassment, discrimination, and blame. Female FACS were less likely to have had gender-concordant mentors. They were more likely to emphasize the importance of gender when determining career aspirations and prioritizing future mentor-mentee relationships. Moving forward, female FACS emphasized the importance of avoiding competition among female surgeons. They encouraged male surgeons to acknowledge gender bias and admit their potential role. Male FACS encouraged male and female surgeons to treat everyone the same.

Conclusions and Relevance

Experiences with gender are not limited to supportive female surgeons. The results of this study emphasize the importance of recognizing the voices of all stakeholders involved when striving to promote workforce diversity and the related need to develop quality improvement/surgical education initiatives that enhance inclusion through open, honest discourse.

Survey of diversity awareness and environment among members of the Pediatric Rheumatology Association of Japan

BACKGROUND

Diversity management has gained traction in Japan. The Pediatric Rheumatology Association of Japan (PRAJ) has an Advisory Committee for Diversity Promotion with a broader focus on promoting diversity. The objectives of this study were to better understand the problems faced by PRAJ members regarding the work environment, childcare and nursing care, and work-life balance.

METHODS

A web-based questionnaire was administered to members of the PRAJ and 79 responses were evaluated.

RESULTS

Of the respondents, 73% were male and 27% were female. A total of 14% worked for more than 12 h on weekdays, and 22% worked for more than 60 h per week and 38% had fewer than 4 days off per month. Regarding childcare, 54% of the respondents were raising preschool children and 83% had taken parental leave for less than 1 year. A total of 17% of participants had family members in need of care. For both childcare and caregiving, the burden was greater for women. Only 18% of the respondents reported a well-balanced work-life balance, and the most common reasons for a lack of balance were not having enough time, heavy workload, and heavy housework load.

CONCLUSIONS

The working hours of the respondents were long, and female members had a greater burden of childcare and caregiving, which was considered a barrier to the career development of women. In the future, there will be a need to promote a sense of equality in diverse human resources, develop support for family life, and shorten working hours.

Society of NeuroInterventional Surgery: position statement on pregnancy and parental leave for physicians practicing neurointerventional surgery

Background

The aim of this article is to outline a position statement on pregnancy and parental leave for physicians practicing neurointerventional surgery.

Methods

We performed a structured literature review regarding parental leave policies in neurointerventional surgery and related fields. The recommendations resulted from discussion among the authors, and additional input from the Women in NeuroIntervention Committee, the full Society of NeuroInterventional Surgery (SNIS) Standards and Guidelines Committee, and the SNIS Board of Directors.

Results

Some aspects of workplace safety during pregnancy are regulated by the US Nuclear Regulatory Commission. Other aspects of the workplace and reasonable job accommodations are legally governed by the Family and Medical Leave Act of 1993, the Affordable Care Act of 2010 and the Fair Labor Standards Act of 1938, Americans with Disabilities Act of 1990, Title IX of the Education Amendments of 1972, Title VII of the Civil Rights Act of 1964 as well as rights and protections put forth by the Occupational Safety and Health Administration as part of the United States Department of Labor. Family friendly policies have been associated not only with improved job satisfaction but also with improved parental and infant outcomes. Secondary effects of such accommodations are to increase the number of women within the specialty.

Conclusions

SNIS supports a physician’s ambition to have a family as well as start, develop, and maintain a career in neurointerventional surgery. Legal and regulatory mandates and family friendly workplace policies should be considered when institutions and individual practitioners approach the issue of childbearing in the context of a career in neurointerventional surgery.