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Naidu SC, Buys YM, Yan DB, Trinh T, Kohly RP. Disparities in cataract surgical training at the University of Toronto based on sex and medical school graduate type. CANADIAN JOURNAL OF OPHTHALMOLOGY 2025; 60:e389-e394. [PMID: 39490052 DOI: 10.1016/j.jcjo.2024.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/17/2023] [Revised: 06/19/2024] [Accepted: 09/29/2024] [Indexed: 11/05/2024]
Abstract
OBJECTIVE To compare sex and medical school graduate type differences in cataract surgical training volumes at Canada's largest residency program, the University of Toronto (UoT). DESIGN Retrospective cohort study PARTICIPANTS: Ophthalmology residents completing cataract surgical training from 2015 to 2020. METHODS Data collected from surgical logbooks at the main cataract surgical teaching site at UoT were analyzed from July 1, 2015, to June 30, 2020. Data collected included stage of resident training and degree of participation for each case. The main outcome measure was mean number of complete cataract cases as a function of resident sex, medical school graduate type, and level of training. RESULTS Thirty-five (19, 54.3% female) residents completed cataract surgical training during the study period. There were 24 (68.6%) Canadian medical graduates (CMGs) and 11 (31.4%) international medical graduates (IMGs). Female residents performed a lower mean number of complete cataract cases compared to males (464.2 versus 504.8, respectively). IMGs completed on average 110.0 (22.8%) fewer cataract cases compared to CMGs. Compared to all residents, female IMGs had the lowest number of complete cataract cases (mean of 380.8 versus 465.7, respectively). The greatest difference occurred between male CMGs and female IMGs, with male CMGs performing 153.8 (40.4%) more complete cases (534.6 vs 380.8, respectively). CONCLUSION The greatest difference in surgical volumes occurred between CMGs and IMGs. Female IMGs had the lowest complete cataract case volumes compared to all residents. Our study highlights novel medical school graduate type disparities in cataract surgical training warranting further exploration.
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Affiliation(s)
- Sumana C Naidu
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Canada
| | - Yvonne M Buys
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Canada
| | - David B Yan
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Canada
| | - Tanya Trinh
- FRANZCO, Sydney Eye Hospital, Mosman Eye Center & Narellan Eye Specialists, Mosman, NSW, Australia
| | - Radha P Kohly
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Canada.
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Maffei JB, Johny A, Park YS, Holmboe E, Hogan SO, Badalato GM, Kraft KH, Mayer WA. The Effect of Gender on Case Log Volumes for Urology Residents: An 11 Year National Study. JOURNAL OF SURGICAL EDUCATION 2025; 82:103515. [PMID: 40318562 DOI: 10.1016/j.jsurg.2025.103515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/23/2024] [Revised: 02/26/2025] [Accepted: 03/22/2025] [Indexed: 05/07/2025]
Abstract
OBJECTIVE This study is the first examination of the relationship between gender and urology residency case log distribution on a national scale. We hypothesized that female urology residents log fewer overall cases and discrepancies exist within index case categories across genders. DESIGN `This study involved a retrospective review of a novel database integrating resident characteristics from multiple national data systems provided by the Accreditation Council for Graduate Medical Education (ACGME). SETTING This study included all graduating trainees from ACGME-accredited urology residencies over an 11-year period. PARTICIPANTS We analyzed 3,335 graduating residents from 145 urology programs over 11 years, between 2013 and 2023. RESULTS The percentage of female urology residents ranged from 21% to 28%, with no significant increase over time (p = 0.575). Total cases per resident increased from an average of 1259 (SD = 288) in 2013 to 1624 (SD = 378) in 2023 (p < 0.001). Female residents logged significantly fewer cases overall: 1,374 (SD = 330) vs. 1423 (SD = 365) for male residents (p < 0.001). Female residents logged significantly fewer cases in 4 of the 11 years, 3 of which were in the past 5 years. Males logged significantly more general urology, endoscopy, and oncology cases than females (p < 0.001 for all). Only pediatrics and reconstruction cases were logged more by females in any year. CONCLUSIONS The number of female urology graduates was statistically unchanged over 11 years. Although meeting required case minimums, females logged significantly fewer cases than males overall and in three of the last 5 years. Addressing this apparent gender gap is essential given the correlation between surgeons' case volumes and patient outcomes.
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Affiliation(s)
| | - Angeline Johny
- Scott Department of Urology, Baylor College of Medicine, Houston, TX
| | - Yoon Soo Park
- Department of Medical Education, University of Illinois College of Medicine, Chicago, IL; Accreditation Council for Graduate Medical Education, Chicago, IL
| | | | - Sean O Hogan
- Department of Medical Education, University of Illinois College of Medicine, Chicago, IL; Accreditation Council for Graduate Medical Education, Chicago, IL
| | - Gina M Badalato
- Department of Urology, Columbia University Vagelos College of Physicians and Surgeons, New York City, NY
| | - Kate H Kraft
- Department of Urology, Ann Arbor, University of Michigan Health, MI
| | - Wesley A Mayer
- Scott Department of Urology, Baylor College of Medicine, Houston, TX.
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Woreta F, Green LK, Sun G. Training Inequities in Ophthalmology-Insights From Educators. JAMA Ophthalmol 2025:2833394. [PMID: 40310616 DOI: 10.1001/jamaophthalmol.2025.1112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2025]
Affiliation(s)
- Fasika Woreta
- Department of Ophthalmology, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Laura K Green
- Department of Ophthalmology, Krieger Eye Institute, Sinai Hospital of Baltimore, Baltimore, Maryland
| | - Grace Sun
- Department of Ophthalmology, Weill Cornell Medicine, New York, New York
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Culican SM, Syed MF, Park YS, Hogan SO. Gender Differences in Case Volume Among Ophthalmology Resident Graduates, 2014-2023. JAMA Ophthalmol 2025:2833393. [PMID: 40310612 PMCID: PMC12046517 DOI: 10.1001/jamaophthalmol.2025.0935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2024] [Accepted: 03/02/2025] [Indexed: 05/02/2025]
Abstract
Importance A previous multisite study found gender differences in cataract and total surgical volume among US residency programs. Whether that was representative of all ophthalmology residents in the US is unclear. Objective To determine whether reported surgical volume among US ophthalmology resident graduates varied by self-reported gender or by underrepresented in medicine (URiM) status. Design, Setting, and Participants Retrospective observational longitudinal cohort study of deidentified Accreditation Council for Graduate Medical Education (ACGME) surgical log data for all graduates of US ophthalmology residency programs from the years 2014-2023 compared by self-reported gender or URiM status. Surgical experience was obtained from the ACGME Accreditation Data System resident case log. Data were analyzed from November 2023 to April 2024. Main Outcomes and Measures The main outcome was a difference in mean reported surgical volume between comparison groups by gender or URiM status for cataract or total surgical procedures. The secondary outcomes were differences for other surgical categories by gender or URiM status. Results Of 4811 resident graduates, 41.6% (1999) were female and 58.4% were male (2812); 7.1% (343) self-identified as URiM. Cataract cases had a mean difference of -4.4% (-8.3 of 189.2) (95% CI, -6.4% to -2.4%; P < .001) fewer surgeries for female residents than male residents over the 10-year study, and total procedures had a mean difference of -7.4% (-43.4 of 587.3) (95% CI, -9.7% to -5.1%; P < .001) fewer surgeries for female than male residents over the 10-year study. URiM status over the same time period was not associated with a difference in cataract surgeries but was associated with a mean difference of -5.3% (-31.5 of 587.3) (95% CI, -9.8% to -0.9%; P = .02) fewer total procedures. Conclusions and Relevance In this study, female residents reported fewer cataract procedures than male residents from 2014-2023. Female and URiM residents reported fewer total procedures than their nonfemale or non-URiM colleagues. Future studies to assess the causes of these disparities are warranted.
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Affiliation(s)
- Susan M. Culican
- Office of Medical Education, Department of Ophthalmology and Visual Neurosciences, University of Minnesota Medical School, Minneapolis
| | - Misha F. Syed
- John Sealy School of Medicine, Department of Ophthalmology and Visual Sciences, University of Texas Medical Branch, Galveston
| | - Yoon Soo Park
- Department of Medical Education, University of Illinois College of Medicine, Chicago
| | - Sean O. Hogan
- Department of Medical Education, University of Illinois College of Medicine, Chicago
- Accreditation Council for Graduate Medical Education, Chicago, Illinois
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Reisinger A, Brücher VC, Krepler K, Liekfeld A. [The glass ceiling in ophthalmology]. DIE OPHTHALMOLOGIE 2025; 122:85-90. [PMID: 39653864 DOI: 10.1007/s00347-024-02152-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/19/2024] [Indexed: 02/04/2025]
Abstract
Currently, two thirds of medical students are female. However, women continue to be clearly underrepresented in leading medical positions, which is also true for ophthalmology. The scientific output of female ophthalmologists is increasing, more pronounced as first authors than last, but remains below that of male colleagues. However, a significant gender bias has been shown in the grant application processes. There are significantly more male surgeons in vitreoretinal, refractive, and corneal surgery. Concerning surgical training, it has been shown that female ophthalmologists operate less during their residency, especially in cataract surgery. Also among surgeons do women continue to shoulder the main responsibility for family and household, despite the negative consequences for their career. This publication presents an overview of the present career situation for women in ophthalmology and discusses possible measures to achieve gender equality, such as the establishment of mentoring programs and networks.
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Affiliation(s)
- Anna Reisinger
- Kepler Universitätsklinikum Linz, Johannes Kepler Universität, Krankenhausstraße 9, Linz, Österreich, 4040.
| | - Viktoria C Brücher
- Klinik für Augenheilkunde, Universitätsklinik Münster, Münster, Deutschland, Domagkstraße 15, 48149
| | - Katharina Krepler
- Klinik Landstraße und Klinik Donaustadt, Wiener Gesundheitsverbund, Wien, Österreich
- Karl Landsteiner Society, Institute for Retinal Research and Imaging, Wien, Österreich
| | - Anja Liekfeld
- Technische Hochschule Brandenburg, Brandenburg an der Havel, Deutschland
- Klinik für Augenheilkunde, Klinikum Ernst von Bergmann GmbH, Potsdam, Deutschland, Charlottenstraße 72, 14467
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Yaïci R, Sanogo M, Lefebvre F, Ní Dhubhghaill S, Aclimandos W, Asoklis R, Atilla H, Creuzot-Garcher C, Curtin D, Cvenkel B, Flanagan L, Kivelä TT, Maino A, Martínez-Costa R, Priglinger S, Prior Filipe H, Stopa M, Strong B, Sturmer J, Tassignon MJ, Ivekovic R, Bourges JL, Rousseau A, Delyfer MN, Mouriaux F, Bourcier T. [Cataract surgery training in France: Analysis of the results of the European Board of Ophthalmology survey in the French cohort]. J Fr Ophtalmol 2025; 48:104383. [PMID: 39700890 DOI: 10.1016/j.jfo.2024.104383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2024] [Revised: 08/06/2024] [Accepted: 09/05/2024] [Indexed: 12/21/2024]
Abstract
OBJECTIVE This study aims to present and analyze the results of the French cohort in a European Board of Ophthalmology (EBO) survey on cataract surgical training in Europe, highlighting the particularities of French training. MATERIALS AND METHODS A 23-question electronic questionnaire was sent to interns applying for the EBO examination from 2018 to 2022. Responses from French participants were specifically collected and analyzed. RESULTS Of 122 responding French ophthalmologists, the mean age was 31.0±2.8 years with an equal distribution between men and women. The most frequent pre-patient training sessions were on virtual reality simulators (8.6±8.2 sessions). French respondents reported a higher average number of partial (124.1±94.8) and complete (96.4±93.1) surgeries, with increased confidence (0-10 scale) in performing simple (7.3±2.4) and complex (5.51±2.6) surgeries, as well as in managing posterior capsular ruptures (7.2±2.5) or performing corneal sutures (3.9±2.7). DISCUSSION Within the European landscape, French cataract surgery training is part of a model of "surgery for all", without gender disparity. Regional variations, however, mark the French landscape, in contrast to other European nations such as Spain and Germany. Standardization of pre-patient training sessions is proposed as a means of equalization. CONCLUSION To standardize cataract surgery training in Europe, it is advisable to establish recommendations and educational strategies, including the standardization of pre-patient training sessions to ensure validation of surgical skills.
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Affiliation(s)
- R Yaïci
- Service d'ophtalmologie, Nouvel Hôpital Civil, hôpitaux universitaires de Strasbourg, BP 426, 67091 Strasbourg, France.
| | - M Sanogo
- Service d'ophtalmologie, Nouvel Hôpital Civil, hôpitaux universitaires de Strasbourg, BP 426, 67091 Strasbourg, France
| | - F Lefebvre
- Service de biostatistiques, hôpitaux universitaires de Strasbourg, Strasbourg, France
| | - S Ní Dhubhghaill
- Service d'ophtalmologie, université de Bruxelles et hôpital universitaire de Bruxelles, Bruxelles, Belgique
| | - W Aclimandos
- Ophtalmologie, King's College Hospital, Londres, Royaume-Uni
| | - R Asoklis
- Service d'ophtalmologie, centre des maladies oculaires, hôpital universitaire de Vilnius Santaros Klinikos, Vilnius, Lituanie
| | - H Atilla
- Service d'ophtalmologie, université d'Ankara, faculté de médecine, Ankara, Turquie
| | - C Creuzot-Garcher
- Service d'ophtalmologie, CHU de Dijon, université de Dijon, Dijon, France
| | - D Curtin
- Royal College of Surgeons in Ireland, Dublin, Irlande
| | - B Cvenkel
- Service d'ophtalmologie, centre médical universitaire de Ljubljana, faculté de médecine, université de Ljubljana, Ljubljana, Slovénie
| | - L Flanagan
- F.S. examen service, service d'ophtalmologie, Ltd, Dublin, Irlande
| | - T T Kivelä
- Service d'ophtalmologie, université d'Helsinki et hôpital universitaire d'Helsinki, Helsinki, Finlande
| | - A Maino
- Manchester Royal Eye Hospital, Manchester, Royaume-Uni
| | - R Martínez-Costa
- Service d'ophtalmologie, Hospital Universitario y Politécnico La Fe, université de Valence, Valence, Espagne
| | - S Priglinger
- Service d'ophtalmologie, LMU Munich, Munich, Allemagne
| | - H Prior Filipe
- Service d'ophtalmologie, centre hospitalier de Lisbonne Ouest, hôpital Egas Moniz, Poznan, Portugal
| | - M Stopa
- Service d'ophtalmologie, hôpital universitaire de Poznan, université des sciences médicales de Poznan, Valence, Espagne
| | - B Strong
- F.S. examen service, service d'ophtalmologie, Ltd, Dublin, Irlande
| | - J Sturmer
- Service d'ophtalmologie, hôpital cantonal de Winterthur, université de Zurich, Zurich, Suisse
| | - M-J Tassignon
- Service d'ophtalmologie, Nouvel Hôpital Civil, hôpitaux universitaires de Strasbourg, BP 426, 67091 Strasbourg, France
| | - R Ivekovic
- Service d'ophtalmologie, centre médical universitaire Sestre Milosrdnice, Zagreb, Croatie
| | - J-L Bourges
- Service d'ophtalmologie, hôpital Cochin, AP-HP, Paris, France
| | - A Rousseau
- Service d'ophtalmologie, hôpital Bicêtre, AP-HP, Paris, France
| | - M-N Delyfer
- Service d'ophtalmologie, hôpital Pellegrin, CHU de Bordeaux, Bordeaux, France
| | - F Mouriaux
- Service d'ophtalmologie, CHU de Rennes, Rennes, France
| | - T Bourcier
- Service d'ophtalmologie, Nouvel Hôpital Civil, hôpitaux universitaires de Strasbourg, BP 426, 67091 Strasbourg, France
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Xu S, McAlpine H, Drummond KJ. The Gender Disparity in Operative Opportunities for Trainee Surgeons: A Review. J Surg Res 2025; 306:327-335. [PMID: 39842046 DOI: 10.1016/j.jss.2024.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Revised: 10/18/2024] [Accepted: 12/05/2024] [Indexed: 01/24/2025]
Abstract
INTRODUCTION Assessing gender disparity in surgical trainees' operative opportunities and experience quantifies implicit gender bias and reflects a summation of many smaller biased interactions within the operating room environment. Highlighting gender disparity in surgery informs a platform for advocacy. METHODS A systematic literature search was performed using Medline, Web of Science, OpenMD and Science Direct consistent with the Preferred Reporting Items for Systematic Reviews and Metanalysis guidelines. A Boolean search strategy was used to identify articles relevant to gender in operative surgery. Only English language studies that assessed the gender of surgical trainees with regards to operative cases for total and/or autonomously performed case numbers were included. RESULTS Fifteen papers assessing the influence of gender on operative opportunities for trainee surgeons were identified. A discrepancy between the operative experiences of men and women trainee surgeons was found. Of eight studies assessing gender differences in total case numbers, four reported women undertaking fewer total cases than men; a similar trend was demonstrated in two studies that failed to reach statistical significance. Eight of eleven studies examining surgical autonomy reported more surgical autonomy afforded to men trainee surgeons than women. CONCLUSIONS A gendered bias in the operative opportunities afforded to trainee surgeons is suggested in the literature, reflecting implicit bias that underlies surgical culture worldwide. Although surgical specialties continue to have vast gender inequity, we fail to leverage talent and the benefits of diverse skills and experience, to the detriment of ourselves and our patients. Quantifying this issue will inform change.
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Affiliation(s)
- Sherri Xu
- Department of Surgery, The University of Melbourne, Parkville, Australia.
| | - Heidi McAlpine
- Department of Surgery, The University of Melbourne, Parkville, Australia; Department of Neurosurgery, The Royal Melbourne Hospital, Parkville, VIC, Australia
| | - Katharine Jann Drummond
- Department of Surgery, The University of Melbourne, Parkville, Australia; Department of Neurosurgery, The Royal Melbourne Hospital, Parkville, VIC, Australia
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Saka N, Yamamoto N, Watanabe J, Wallis C, Jerath A, Someko H, Hayashi M, Kamijo K, Ariie T, Kuno T, Kato H, Mohamud H, Chang A, Satkunasivam R, Tsugawa Y. Comparison of Postoperative Outcomes Among Patients Treated by Male Versus Female Surgeons: A Systematic Review and Meta-analysis. Ann Surg 2024; 280:945-953. [PMID: 38726676 PMCID: PMC11542977 DOI: 10.1097/sla.0000000000006339] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/13/2024]
Abstract
OBJECTIVE To compare clinical outcomes of patients treated by female surgeons versus those treated by male surgeons. BACKGROUND It remains unclear as to whether surgical performance and outcomes differ between female and male surgeons. METHODS We conducted a meta-analysis to compare patients' clinical outcomes-including patients' postoperative mortality, readmission, and complication rates-between female versus male surgeons. MEDLINE, Embase, CENTRAL, ICTRP, and ClinicalTrials.gov were searched from inception to September 8, 2022. The update search was conducted on July 19, 2023. We used random-effects models to synthesize data and GRADE to evaluate the certainty. RESULTS A total of 15 retrospective cohort studies provided data on 5,448,121 participants. We found that patients treated by female surgeons experienced a lower postoperative mortality compared with patients treated by male surgeons [8 studies; adjusted odds ratio (aOR), 0.93; 95% CI, 0.88-0.97; I2 =27%; moderate certainty of the evidence]. We found a similar pattern for both elective and nonelective (emergent or urgent) surgeries, although the difference was larger for elective surgeries (test for subgroup difference P =0.003). We found no evidence that female and male surgeons differed for patient readmission (3 studies; aOR, 1.20; 95% CI, 0.83-1.74; I2 =92%; very low certainty of the evidence) or complication rates (8 studies; aOR, 0.94; 95% CI, 0.88-1.01; I2 =38%; very low certainty of the evidence). CONCLUSION This systematic review and meta-analysis suggests that patients treated by female surgeons have a lower mortality compared with those treated by male surgeons.
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Affiliation(s)
- Natsumi Saka
- Department of Orthopedics, Teikyo University School of Medicine, Tokyo, Japan
- Scientific Research WorkS Peer Support Group (SRWS-PSG), Chuo, Osaka Prefecture, Japan
| | - Norio Yamamoto
- Scientific Research WorkS Peer Support Group (SRWS-PSG), Chuo, Osaka Prefecture, Japan
- Department of Epidemiology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Okayama Prefecture, Japan
| | - Jun Watanabe
- Scientific Research WorkS Peer Support Group (SRWS-PSG), Chuo, Osaka Prefecture, Japan
- Department of Surgery, Division of Gastroenterological, General and Transplant Surgery, Jichi Medical University, Yakushiji Shimotsuke, Tochigi Prefecture, Japan
- Center for Community Medicine, Jichi Medical University, Yakushiji Shimotsuke, Tochigi Prefecture, Japan
| | - Christopher Wallis
- Department of Surgery, Division of Urology, University of Toronto, Toronto, ON, Canada
- Department of Surgery, Division of Urology, Mount Sinai Hospital, Toronto, ON, Canada
- Department of Surgical Oncology, University Health Network, Toronto, ON, Canada
| | - Angela Jerath
- Department of Anesthesia, Sunnybrook Health Sciences Center, Toronto, ON, Canada
| | - Hidehiro Someko
- Scientific Research WorkS Peer Support Group (SRWS-PSG), Chuo, Osaka Prefecture, Japan
- Department of General Internal Medicine, Asahi General Hospital, Asahi, Chiba Prefecture, Japan
| | - Minoru Hayashi
- Scientific Research WorkS Peer Support Group (SRWS-PSG), Chuo, Osaka Prefecture, Japan
- Department of Emergency Medicine, Fukui Prefectural Hospital, Fukui, Japan
| | - Kyosuke Kamijo
- Scientific Research WorkS Peer Support Group (SRWS-PSG), Chuo, Osaka Prefecture, Japan
- Department of Gynecology, Nagano Municipal Hospital, Nagano, Japan
| | - Takashi Ariie
- Scientific Research WorkS Peer Support Group (SRWS-PSG), Chuo, Osaka Prefecture, Japan
- Department of Physical Therapy, School of Health Sciences at Fukuoka, International University of Health and Welfare, Okawa, Fukuoka Prefecture, Japan
| | - Toshiki Kuno
- Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, New York, NY
| | - Hirotaka Kato
- School of Economics and Business Administration, Yokohama City University, Yokohama, Japan
| | - Hodan Mohamud
- Department of Surgery, Division of Urology, University of Toronto, Toronto, ON, Canada
| | - Ashton Chang
- Department of Anesthesia, Sunnybrook Health Sciences Center, Toronto, ON, Canada
| | - Raj Satkunasivam
- Department of Urology, Houston Methodist Hospital, Houston, TX
- Center for Outcomes Research, Houston Methodist Hospital, Houston, TX
- Department of Health Policy and Management, School of Public Health, Texas A&M University, College Station, TX
| | - Yusuke Tsugawa
- Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at UCLA, Los Angeles, CA
- Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, CA
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9
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Vought R, Vought V, Shah E, Khouri AS. Demographics and Research Activity Among 2023 Academic Glaucoma Specialists. Semin Ophthalmol 2024; 39:299-304. [PMID: 38078456 DOI: 10.1080/08820538.2023.2293029] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 11/23/2023] [Indexed: 03/28/2024]
Abstract
PURPOSE To characterize demographics, academic characteristics, and research activity of academic glaucoma specialists. METHODS Faculty demographic and academic data were recorded for glaucoma specialist faculty from 99 United States ophthalmology residency programs using institutional websites, Doximity, and LinkedIn. H-index was calculated using Scopus. Mean and weighted relative citation ratio (RCR), measuring research impact and productivity, respectively, was determined with the National Institute of Health iCite tool. RESULTS Most academic glaucoma specialists were men (0.61), located in the Southern United States (0.316), and in practice for less than or equal to 10 years in 2023 (0.324). Twenty-six percent had additional professional degrees, and 11% completed fellowship training in addition to clinical glaucoma. Assistant professor was the most common academic appointment (0.479), and almost a quarter (0.23) had additional positions. Mean h-index (13.3), mean-RCR (1.76), and weighted-RCR (84.0) were consistent with high research productivity and impact. Gender comparison found that men had significantly higher h-index (p < .001), m-RCR (p = .007), w-RCR (p < .001) as compared to women. H-index (p < .001; p < .001; p < .001), m-RCR (p = .006; p < .001; p < .001), and w-RCR (p < .001; p < .001; p < .001) also increased with career duration, academic position, and additional academic appointments, respectively. Additional training was associated with higher h-index (p = .023) and w-RCR (p = .012), but not m-RCR (p = .699). CONCLUSION Higher research activity is significantly associated with higher departmental positions and additional academic appointments. This illustrates the importance of research contributions for academic promotion. Variations in research activity by gender distribution may therefore affect opportunities for career advancement.
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Affiliation(s)
- Rita Vought
- Department of Ophthalmology and Visual Science, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Victoria Vought
- Department of Ophthalmology and Visual Science, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Esha Shah
- Department of Ophthalmology and Visual Science, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Albert S Khouri
- Department of Ophthalmology and Visual Science, Rutgers New Jersey Medical School, Newark, NJ, USA
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Lenaine Westney O. Editorial Comment. Urology 2024; 185:24-25. [PMID: 38336132 DOI: 10.1016/j.urology.2024.01.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Accepted: 01/17/2024] [Indexed: 02/12/2024]
Affiliation(s)
- Ouida Lenaine Westney
- Department of Urology, University of Texas - MD Anderson Cancer Center, Houston, TX.
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Marchetti KA, Ferreri CA, Bethel EC, Lesser-Lee B, Daignault-Newton S, Merrill S, Badalato GM, Brown ET, Guzzo T, Houston Thompson R, Klausner A, Lee R, Parekh DJ, Raman JD, Reese A, Shenot P, Williams DH, Zaslau S, Kraft KH. Gender-based Disparity Exists in the Surgical Experience of Female and Male Urology Residents. Urology 2024; 185:17-23. [PMID: 38336129 DOI: 10.1016/j.urology.2023.11.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 10/31/2023] [Accepted: 11/28/2023] [Indexed: 02/12/2024]
Abstract
OBJECTIVE To determine if a discrepancy exists in the number and type of cases logged between female and male urology residents. MATERIALS AND METHODS ACGME case log data from 13 urology residency programs was collected from 2007 to 2020. The number and type of cases for each resident were recorded and correlated with resident gender and year of graduation. The median, 25th and 75th percentiles number of cases were calculated by gender, and then compared between female and male residents using Wilcoxon rank sum test. RESULTS A total of 473 residents were included in the study, 100 (21%) were female. Female residents completed significantly fewer cases, 2174, compared to male residents, 2273 (P = .038). Analysis by case type revealed male residents completed significantly more general urology (526 vs 571, P = .011) and oncology cases (261 vs 280, P = .026). Additionally, female residents had a 1.3-fold increased odds of logging a case in the assistant role than male residents (95% confidence interval: 1.27-1.34, P < .001). CONCLUSION Gender-based disparity exists within the urology training of female and male residents. Male residents logged nearly 100 more cases than female residents over 4years, with significant differences in certain case subtypes and resident roles. The ACGME works to provide an equal training environment for all residents. Addressing this finding within individual training programs is critical.
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Affiliation(s)
- Kathryn A Marchetti
- University of Pittsburgh Medical Center, Department of Urology, Pittsburgh, PA.
| | - Charles A Ferreri
- Vanderbilt University Medical Center, Department of Urology, Nashville, TN
| | - Emma C Bethel
- University of North Carolina School of Medicine, Department of Urology, Chapel Hill, NC
| | | | | | | | | | - Elizabeth T Brown
- MedStar Georgetown University Hospital, Department of Urology, Washington, DC
| | - Thomas Guzzo
- University of Pennsylvania, Department of Urology, Philadelphia, PA
| | | | - Adam Klausner
- Virginia Commonwealth University, Division of Urology, Richmond, VA
| | - Richard Lee
- Weill Cornell Medicine, Department of Urology, New York, NY
| | - Dipen J Parekh
- University of Miami Health System, Department of Urology, Miami, FL
| | - Jay D Raman
- Pennsylvania State University College of Medicine, Department of Urology, Hershey, PA
| | - Adam Reese
- Temple University, Department of Urology, Philadelphia, PA
| | - Patrick Shenot
- Jefferson Health, Department of Urology, Philadelphia, PA
| | | | - Stanley Zaslau
- West Virginia University School of Medicine Urology, Morgantown, WV
| | - Kate H Kraft
- University of Michigan Health System, Department of Urology, Ann Arbor, MI
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12
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Barequet IS, Rosenblatt A, Schaap Fogler M, Pedut-Kloizman T, Gaton D, Loewenstein A, Habot-Wilner Z. Gender related trends among Israeli ophthalmologists professional career and personal life performance. Eye (Lond) 2023; 37:3496-3501. [PMID: 37106146 PMCID: PMC10630451 DOI: 10.1038/s41433-023-02543-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 01/17/2023] [Accepted: 04/13/2023] [Indexed: 04/29/2023] Open
Abstract
BACKGROUND Gender-diversity trends in ophthalmology in Israel have not been studied despite a high proportion of female ophthalmologists. Our purpose was to evaluate gender-related trends in ophthalmology professional career and personal life performance in early and advanced careers in Israel. METHODS A survey based on a nationwide voluntary anonymous web questionnaire was distributed to the members of the Israeli Ophthalmological Society. The questionnaire included questions referring to professional career and personal life performance. Gender differences were analyzed. RESULTS Out of 252 respondents, 116 (46%) were women, with a mean age of 47.97 + -11.3 and 53.18 + -12.4 (P = 0.01) years, respectively. Marital status, post-residency fellowship performance or duration, an additional academic degree, academic appointments, and managerial positions were similar between genders. Fellowship predominance of males was found in cornea/cataract/refractive and of females in strabismus, pediatric ophthalmology, and neuro-ophthalmology (P < 0.01, P = 0.032, respectively). Men had significantly more publications and appointments in peer review journals and work hours (P = 0.04 and P = 0.02, P = 0.027, respectively). Both genders responded similarly regarding work satisfaction, combination between family life and work. More women felt inequity during and post-residency in clinical (P = 0.011, P = 0.001, respectively) and surgical work (P = 0.001, P = 0.035, respectively). More women experienced inappropriate remarks from patients and sexual harassment (P = 0.001, P < 0.001, respectively), and supported the need for affirmative action (P < 0.0001). CONCLUSIONS Several gender disparities were found among ophthalmologists in Israel, including subspecialties distributions, publications, appointments in peer review journals, working hours, work inequity sense, harassment events, and support the need for affirmative action.
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Affiliation(s)
- Irina S Barequet
- Goldschleger Eye Institute, Sheba Medical Center, Ramat Gan, Israel.
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Amir Rosenblatt
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Division of Ophthalmology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Michal Schaap Fogler
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Ophthalmology, Rabin Medical Center, Petach Tikva, Israel
| | | | - Dan Gaton
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Ophthalmology, Rabin Medical Center, Petach Tikva, Israel
| | - Anat Loewenstein
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Division of Ophthalmology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Zohar Habot-Wilner
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Division of Ophthalmology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
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13
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Ní Dhubhghaill S, Sanogo M, Lefebvre F, Aclimandos W, Asoklis R, Atilla H, Creuzot-Garcher C, Curtin D, Cvenkel B, Flanagan L, Kivelä TT, Maino A, Martinez Costa R, Priglinger S, Prior Filipe H, Stopa M, Strong B, Sturmer J, Tassignon MJ, Ivekovic R, Bourcier T. Cataract surgical training in Europe: European Board of Ophthalmology survey. J Cataract Refract Surg 2023; 49:1120-1127. [PMID: 37867285 DOI: 10.1097/j.jcrs.0000000000001280] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 08/02/2023] [Indexed: 10/24/2023]
Abstract
PURPOSE To survey recently graduated European ophthalmologists concerning cataract surgery (CS) training opportunities. SETTING Countries affiliated to the European Board of Ophthalmology (EBO). DESIGN Cross-sectional study of anonymous survey results. METHODS A 23-question online survey was emailed to candidates who sat the EBO Diploma Examination as residents between 2018 and 2022. RESULTS 821 ophthalmologists from 30 countries completed the survey. The mean residency duration was 4.73 (SD 0.9) years. The mean reported number of entire CS procedures performed was 80.7 (SD 100.6) at the end of residency, but more than 25% of respondents (n = 210) had received no live CS training during their residency. The self-confidence (scale, 1 to 10) to perform a simple case or challenging case, manage posterior capsular rupture, and realize a corneal stitch were rated 4.1, 3.2, 4.2, 2.4, respectively. We observed extensive variation in clinical exposure to CS and self-reported confidence to perform CS between European trainees. Females reported a mean of 18% fewer entire procedures than their male colleagues and were also less confident in their surgical skills (P < .05). Trainees in residency programs longer than 5 years performed fewer procedures and were less confident than trainees in residences of shorter duration (P < .001). The importance of fellowships to complete surgical education was rated 7.7 out of 10. CONCLUSIONS CS training across European countries lacks harmony. Female ophthalmology trainees continue, as in other specialties, to experience apparent gender bias. European level recommendations seem necessary to raise and harmonize competency-based CS training programs and promote post-residency fellowship training programs.
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Affiliation(s)
- Sorcha Ní Dhubhghaill
- From the Department of Ophthalmology, Antwerp University and University Hospital of Antwerp, Antwerp, Belgium (Ní Dhubhghaill, Tassignon); Department of Ophthalmology, Strasbourg University Hospital, NHC, FMTS, University of Strasbourg, Strasbourg, France (Sanogo, Bourcier); Department of Biostatistics, Strasbourg University Hospital, Civil Hospital, FMTS, University of Strasbourg, Strasbourg, France (Lefebvre); King's College Hospital, London, United Kingdom (Aclimandos); Department of Ophthalmology, Center of Eye Diseases, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania (Asoklis); Department of Ophthalmology, Ankara University, School of Medicine, Ankara, Turkey (Atilla); Department of Ophthalmology, Dijon University Hospital, University of Dijon, Dijon, France (Creuzot-Garcher); Consultant Ophthalmologist, Clinical Lecturer, Royal College of Surgeons in Ireland, Dublin, Ireland (Curtin); Department of Ophthalmology, University Medical Centre Ljubljana, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia (Cvenkel); EBO Secretariat Office, Agenda Communications and Conference Services, Ltd., Dublin, Ireland (Flanagan, Strong); Department of Ophthalmology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland (Kivelä); Manchester Royal Eye Hospital, Manchester, United Kingdom (Maino); Department of Ophthalmology, Hospital Universitario y Politécnico La Fe, University of Valencia, Valencia, Spain (Martinez Costa); Department of Ophthalmology, LMU Munich, Germany (Priglinger); Department of Ophthalmology, West Lisbon Hospitals Center, Hospital Egas Moniz, Portugal (Prior Filipe); Department of Ophthalmology, Poznan University Hospital, Poznan University of Medical Sciences, Poland (Stopa); Department of Ophthalmology, Cantonal Hospital Winterthur, University of Zurich, Switzerland (Sturmer); Department of Ophthalmology, University Medical Centre Sestre Milosrdnice, Zagreb, Croatia (Ivekovic)
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14
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Kouanda A, Bayudan A, Hussain A, Avila P, Kamal F, Hasan MK, Dai SC, Munroe C, Thiruvengadam N, Arain MA. Current state of biliary cannulation techniques during endoscopic retrograde cholangiopancreatography (ERCP): International survey study. Endosc Int Open 2023; 11:E588-E598. [PMID: 37564727 PMCID: PMC10410689 DOI: 10.1055/a-2085-4565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 04/19/2023] [Indexed: 08/12/2023] Open
Abstract
Background and study aims Endoscopist techniques affect biliary cannulation success and the risk of adverse events during endoscopic retrograde cholangiopancreatography (ERCP). This survey study aims to understand the current practice of biliary cannulation techniques among endoscopists. Methods Practicing endoscopists were sent an anonymous 28-question electronic survey on biliary cannulation techniques and intraprocedural pancreatitis prophylactic strategies. Results The survey was completed by 692 endoscopists (6.2% females). A wire-guided cannulation technique (WGT) was the preferred initial biliary cannulation approach (95%). The preferred secondary approaches were a double-wire (DWT) (65.8%), precut needle-knife technique (NKT) (25.7%), transpancreatic sphincterotomy (5.9%) or other (2.6%). Overall, 18.1% of respondents were not comfortable with NKTs. In the setting of pancreatic duct (PD) access, 81.9% and 97% reported a threshold of three or more wire passes or contrast injections into the PD, respectively, before changing strategy, 34% reported placement of a prophylactic PD stent <50% of the time and 12.1% reported removal of the PD stent at the end of the procedure. Advanced endoscopy fellowship (AEF) training and high volume (>200 ERCPs per year) were associated with comfort with precut NKTs and likelihood of prophylactic PD stent ( P <0.001 for both). Conclusions A WGT technique followed by the DWT and NKT were the preferred biliary cannulation techniques; however, almost one-fifth of respondents were not comfortable with the NKT. There was considerable variability in secondary cannulation approaches, time spent attempting biliary cannulation and prophylactic PD stent placement, factors known to be associated with cannulation success and adverse outcomes.
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Affiliation(s)
- Abdul Kouanda
- Gastroenterology, University of California San Francisco Medical Center at Parnassus, San Francisco, United States
| | - Alexis Bayudan
- Gastroenterology, University of California San Francisco Medical Center at Parnassus, San Francisco, United States
| | - Azhar Hussain
- Medicine, Ameer-ud-Din Medical College of PGMI, Lahore, Pakistan
| | - Patrick Avila
- Gastroenterology, University of California San Francisco Medical Center at Parnassus, San Francisco, United States
| | - Faisal Kamal
- Gastroenterology, University of Tennessee Health Science Center, Memphis, United States
| | - Muhammad Khalid Hasan
- Center for Interventional Endoscopy, Florida Hospital Orlando, Orlando, United States
| | - Sun-Chuan Dai
- Gastroenterology, University of California San Francisco Medical Center at Parnassus, San Francisco, United States
| | - Craig Munroe
- Gastroenterology, University of California San Francisco Medical Center at Parnassus, San Francisco, United States
| | | | - Mustafa A Arain
- Center for Interventional Endoscopy, AdventHealth Orlando, Orlando, United States
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15
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Rei KM, Reddy V, Mohammed S, Kashyap S, Cathel A, Siddiqi J. Gender Differences in Surgical Case Volume Among Neurosurgery Residents. Cureus 2023; 15:e35798. [PMID: 37033513 PMCID: PMC10075184 DOI: 10.7759/cureus.35798] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/04/2023] [Indexed: 03/07/2023] Open
Abstract
OBJECTIVES Gender differences in surgical training opportunities, measured by case volume, have been demonstrated in the fields of otolaryngology and ophthalmology. We hypothesize that this gender disparity is not present among neurosurgery residents. This study compares median female and male case volumes stratified by postgraduate year (PGY) level for U.S. neurosurgery residents. METHODS This retrospective analysis included case log data from two southern California neurosurgery residency training programs, Riverside University Health System (RUHS) and Desert Regional Medical Center (DRMC), from 2015 to 2021. For each PGY level, gender differences in case volumes were summarized using median, SD, and two-sided t-tests. RESULTS Among 47 (19.1% female) neurosurgery residents, there were no significant gender differences in case volumes across any PGY levels. Female residents had greater median surgical cases during PGY-1 (median (SD), female 107.0 (13.1) vs male 102.0 (24.3); p=0.841) and PGY-7 (female 282.5 (17.7) vs male 246 (60.9); P=0.424), while male residents had greater median case volumes for all other PGY levels. CONCLUSIONS Although previous studies have found significant gender differences in case volumes among surgical residents in otolaryngology and ophthalmology, case log data from two neurosurgery residency programs in southern California, RUHS and DRMC, does not reflect this gender disparity at any PGY level.
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16
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LGBTQ+ Identity and Ophthalmologist Burnout. Am J Ophthalmol 2023; 246:66-85. [PMID: 36252675 DOI: 10.1016/j.ajo.2022.10.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 09/29/2022] [Accepted: 10/03/2022] [Indexed: 01/24/2023]
Abstract
PURPOSE To evaluate lesbian, gay, bisexual, transgender, questioning, and other sexual/gender minority (LGBTQ+) orientation as a burnout risk factor among an international ophthalmologist cohort. METHODS An anonymous, cross-sectional electronic survey was distributed via an Internet platform to characterize the relationship among demographic factors, including LGBTQ+ orientation, and burnout as measured by the Copenhagen Burnout Inventory (CBI). Univariable data analysis (linear) by sexual orientation was performed and variables with an association with a P value of <0.15 in univariable analysis were included in the multiple linear regression modeling. RESULTS A total of 403 ophthalmologists participated in the survey. The majority self-identified as "White" (69.2%), were from North America (72.0% United States, 18.6% Canada) and were evenly distributed between age of 30 and 65 years. Overall, 13.2% of participants identified as LGBTQ+ and 98.2% as cisgender. Approximately 12% had witnessed or experienced LGBTQ+-related workplace discrimination or harassment. The personal and work-related burnout scores and confidence limits of persons identified as LGBTQ+ were higher and nonoverlapping compared with those reported as non-LGBTQ+. Multivariable analysis identified significant risk factors for higher personal and work-related burnout scores: LGBTQ+ (11.8 and 11.1, P = .0005 and .0023), female gender (5.36 and 4.83, P = .0153 and .0434), older age (19.1 and 19.2, P = .0173 and .0273). and caretaker stress (6.42 and 5.97, P = .0085 and .0239). CONCLUSIONS LGBTQ+ orientation is a burnout risk factor among ophthalmologists, and LGBTQ+ workplace discrimination may be a contributing factor. Support from ophthalmology organizations to address LGBTQ+-, gender-, and age-related workplace discrimination may decrease burnout. NOTE: Publication of this article is sponsored by the American Ophthalmological Society.
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17
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List W, Steinwender G, Glatz W, Riedl R, Wedrich A, Ivastinovic D. The impact of surgeon's experience and sex on the incidence of cystoid macular edema after uneventful cataract surgery. PLoS One 2022; 17:e0279518. [PMID: 36574394 PMCID: PMC9794095 DOI: 10.1371/journal.pone.0279518] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Accepted: 11/22/2022] [Indexed: 12/29/2022] Open
Abstract
PURPOSE To assess the rate of pseudophakic cystoid macular edema (pCME) in uneventful cataract surgery in surgeons in training vs experienced surgeons and to analyze the rate of pCME according to surgeon's sex. METHODS Medical reports post phacoemulsification between 2010 and 2018 at the Department of Ophthalmology, Medical University of Graz, Austria, were reviewed for pCME. A running lifetime number of preceding cataract surgeries was used to express hands-on experience. A cut-off number of 300 surgeries was defined to distinguish between surgeons in training and experienced surgeons. Outcome parameters were incidence of pCME, patient's sex and age, laterality of eye, coexistence of pseudoexfoliation syndrome (PEX), duration of surgery and surgeon's sex. RESULTS 25.422 surgeries on 18.266 patients were included. The majority was performed by experienced surgeons (23.139, 91.0%) vs 2.283 (9.0%) by surgeons in training (25 surgeons, 9 (36%) female and 16 (64%) male). pCME occurred in 32 eyes (1.4%) following surgery by surgeons in training and in 152 eyes (0.7%) following surgery by experienced surgeons. Chance for pCME was 1.57 higher in training surgeries (95% CI 1.03-2.41, p = 0.034) and longer duration (OR = 1.04; 95% CI 1.02-1.07, p = 0.001). After excluding the first 100 surgeries for every surgeon in training similar results were observed. No difference in risk for pCME was found between female and male surgeons in both groups (training and experienced surgeons). CONCLUSION In conclusion, the rate for pCME after uneventful cataract surgery is significantly higher for surgeons in training but steadily decreasing and associated to surgical time. No difference in the risk for pCME was found between female and male surgeons.
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Affiliation(s)
- Wolfgang List
- Department of Ophthalmology, Medical University of Graz, Graz, Austria
- * E-mail:
| | | | - Wilfried Glatz
- Department of Ophthalmology, Medical University of Graz, Graz, Austria
| | - Regina Riedl
- Institute for Medical Informatics, Statistics and Documentation, Medical University of Graz, Graz, Austria
| | - Andreas Wedrich
- Department of Ophthalmology, Medical University of Graz, Graz, Austria
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Okoshi K, Endo H, Nomura S, Kono E, Fujita Y, Yasufuku I, Hida K, Yamamoto H, Miyata H, Yoshida K, Kakeji Y, Kitagawa Y. Comparison of short term surgical outcomes of male and female gastrointestinal surgeons in Japan: retrospective cohort study. BMJ 2022; 378:e070568. [PMID: 36170985 DOI: 10.1136/bmj-2022-070568] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To compare short term surgical outcomes between male and female gastrointestinal surgeons in Japan. DESIGN Retrospective cohort study. SETTING Data from the Japanese National Clinical Database (includes data on >95% of surgeries performed in Japan) (2013-17) and the Japanese Society of Gastroenterological Surgery. PARTICIPANTS Male and female surgeons who performed distal gastrectomy, total gastrectomy, and low anterior resection. MAIN OUTCOME MEASURES Surgical mortality, surgical mortality combined with postoperative complications, pancreatic fistula (distal gastrectomy/total gastrectomy only), and anastomotic leakage (low anterior resection only). The association of surgeons' gender with surgery related mortality and surgical complications was examined using multivariable logistic regression models adjusted for patient, surgeon, and hospital characteristics. RESULTS A total of 149 193 distal gastrectomy surgeries (male surgeons: 140 971 (94.5%); female surgeons: 8222 (5.5%)); 63 417 gastrectomy surgeries (male surgeons: 59 915 (94.5%); female surgeons: 3502 (5.5%)); and 81 593 low anterior resection procedures (male surgeons: 77 864 (95.4%);female surgeons: 3729 (4.6%)) were done. On average, female surgeons had fewer post-registration years, operated on patients at higher risk, and did fewer laparoscopic surgeries than male surgeons. No significant difference was found between male and female surgeons in the adjusted risk for surgical mortality (adjusted odds ratio 0.98 (95% confidence interval 0.74 to 1.29) for distal gastrectomy; 0.83 (0.57 to 1.19) for total gastrectomy; 0.56 (0.30 to 1.05) for low anterior resection), surgical mortality combined with Clavien-Dindo grade ≥3 complications (adjusted odds ratio 1.03 (0.93 to 1.14) for distal gastrectomy; 0.92 (0.81 to 1.05) for total gastrectomy; 1.02 (0.91 to 1.15) for low anterior resection), pancreatic fistula (adjusted odds ratio 1.16 (0.97 to 1.38) for distal gastrectomy; 1.02 (0.84 to 1.23) for total gastrectomy), and anastomotic leakage (adjusted odds ratio 1.04 (0.92 to 1.18) for low anterior resection). CONCLUSION This study found no significant adjusted risk difference in the outcomes of surgeries performed by male versus female gastrointestinal surgeons. Despite disadvantages, female surgeons take on patients at high risk. Greater access to surgical training for female physicians is warranted in Japan.
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Affiliation(s)
- Kae Okoshi
- Department of Surgery, Japan Baptist Hospital, Kyoto, Japan
- Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
- Contributed equally
| | - Hideki Endo
- Department of Healthcare Quality Assessment, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
- Contributed equally
| | - Sachiyo Nomura
- Department of Gastrointestinal Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Emiko Kono
- Department of General and Gastroenterological Surgery, Osaka Medical and Pharmaceutical University, Takatsuki, Japan
| | - Yusuke Fujita
- Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Itaru Yasufuku
- Department of Surgical Oncology, Gifu University School of Medicine, Gifu, Japan
| | - Koya Hida
- Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Hiroyuki Yamamoto
- Department of Healthcare Quality Assessment, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Hiroaki Miyata
- Department of Healthcare Quality Assessment, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Kazuhiro Yoshida
- Department of Surgical Oncology, Gifu University School of Medicine, Gifu, Japan
| | - Yoshihiro Kakeji
- Database Committee, Japanese Society of Gastroenterological Surgery, Tokyo, Japan
| | - Yuko Kitagawa
- Japanese Society of Gastroenterological Surgery, Tokyo, Japan
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Cai CX, Klawe J, Ahmad S, Zeger SL, Wang J, Sun G, Ramulu P, Srikumaran D. Geographic variations in gender differences in cataract surgery volume among a national cohort of ophthalmologists. J Cataract Refract Surg 2022; 48:1023-1030. [PMID: 35318293 PMCID: PMC9415203 DOI: 10.1097/j.jcrs.0000000000000938] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 03/16/2022] [Indexed: 11/25/2022]
Abstract
PURPOSE To assess factors associated with gender disparities in cataract surgery volume and evaluate how these differences have changed over time. SETTING Cataract surgeons in the 2012 to 2018 Medicare database. DESIGN Retrospective study. METHODS The association of provider gender with the number of cataract surgeries per office visit billed was assessed with negative binomial regression models, controlling for calendar year, years in practice, hospital affiliation, geographic region, rurality, density of ophthalmologists, and the national percentile of Area Deprivation Index (ADI) score for the practice location. RESULTS There were 8480 cataract surgeons, most of whom were male (78%). Male surgeons worked in more deprived areas with a higher ADI (median: 40 vs 33, P < .001). Female surgeons performed fewer cataracts per year (140 [95% CI, 126-154] vs 276 [95% CI, 263-288], P < .001) and billed fewer office visits (1038 [95% CI, 1008-1068] vs 1505 [95% CI, 1484-1526], P < .001). In multivariate analysis, the number of cataract surgeries per office visit was greater for males compared with females in all years in the South (average incidence rate ratio 1.80), Midwest (1.50), and West (1.53), but not in the Northeast (1.16). The relative rate of cataract surgeries between male and female surgeons in each region did not change significantly over time from 2012 to 2018 ( P > .05 in each region). CONCLUSIONS Gender disparities in cataract volume among male and female surgeons have remained unchanged over time from 2012 to 2018. The higher cataract volume among male surgeons may be explained in part by provider practice location. Further studies are needed to better understand and address gender disparities.
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Affiliation(s)
- Cindy X. Cai
- From the Wilmer Eye Institute, Johns Hopkins Hospital, Baltimore, Maryland (Cai, Ramulu, Srikumaran); Icahn School of Medicine of Mount Sinai, New York, New York (Klawe, Ahmad); Department of Biostatistics, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland (Zeger, Wang); Department of Ophthalmology, Weill Cornell Medical College, New York, New York (Sun)
| | - Janek Klawe
- From the Wilmer Eye Institute, Johns Hopkins Hospital, Baltimore, Maryland (Cai, Ramulu, Srikumaran); Icahn School of Medicine of Mount Sinai, New York, New York (Klawe, Ahmad); Department of Biostatistics, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland (Zeger, Wang); Department of Ophthalmology, Weill Cornell Medical College, New York, New York (Sun)
| | - Sumayya Ahmad
- From the Wilmer Eye Institute, Johns Hopkins Hospital, Baltimore, Maryland (Cai, Ramulu, Srikumaran); Icahn School of Medicine of Mount Sinai, New York, New York (Klawe, Ahmad); Department of Biostatistics, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland (Zeger, Wang); Department of Ophthalmology, Weill Cornell Medical College, New York, New York (Sun)
| | - Scott L. Zeger
- From the Wilmer Eye Institute, Johns Hopkins Hospital, Baltimore, Maryland (Cai, Ramulu, Srikumaran); Icahn School of Medicine of Mount Sinai, New York, New York (Klawe, Ahmad); Department of Biostatistics, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland (Zeger, Wang); Department of Ophthalmology, Weill Cornell Medical College, New York, New York (Sun)
| | - Jiangxia Wang
- From the Wilmer Eye Institute, Johns Hopkins Hospital, Baltimore, Maryland (Cai, Ramulu, Srikumaran); Icahn School of Medicine of Mount Sinai, New York, New York (Klawe, Ahmad); Department of Biostatistics, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland (Zeger, Wang); Department of Ophthalmology, Weill Cornell Medical College, New York, New York (Sun)
| | - Grace Sun
- From the Wilmer Eye Institute, Johns Hopkins Hospital, Baltimore, Maryland (Cai, Ramulu, Srikumaran); Icahn School of Medicine of Mount Sinai, New York, New York (Klawe, Ahmad); Department of Biostatistics, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland (Zeger, Wang); Department of Ophthalmology, Weill Cornell Medical College, New York, New York (Sun)
| | - Pradeep Ramulu
- From the Wilmer Eye Institute, Johns Hopkins Hospital, Baltimore, Maryland (Cai, Ramulu, Srikumaran); Icahn School of Medicine of Mount Sinai, New York, New York (Klawe, Ahmad); Department of Biostatistics, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland (Zeger, Wang); Department of Ophthalmology, Weill Cornell Medical College, New York, New York (Sun)
| | - Divya Srikumaran
- From the Wilmer Eye Institute, Johns Hopkins Hospital, Baltimore, Maryland (Cai, Ramulu, Srikumaran); Icahn School of Medicine of Mount Sinai, New York, New York (Klawe, Ahmad); Department of Biostatistics, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland (Zeger, Wang); Department of Ophthalmology, Weill Cornell Medical College, New York, New York (Sun)
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20
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Zhang JH, Adewole AT, Ramke J, Buchan J. Publishing opportunities and gender equity: Embedding monitoring in eye health education. Clin Exp Ophthalmol 2022; 50:809-811. [DOI: 10.1111/ceo.14123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Accepted: 05/28/2022] [Indexed: 11/27/2022]
Affiliation(s)
- Justine H. Zhang
- International Centre for Eye Health London School of Hygiene & Tropical Medicine London UK
- Royal Free Hospital London UK
| | | | - Jacqueline Ramke
- International Centre for Eye Health London School of Hygiene & Tropical Medicine London UK
- School of Optometry and Vision Science University of Auckland Auckland New Zealand
| | - John Buchan
- International Centre for Eye Health London School of Hygiene & Tropical Medicine London UK
- Leeds Teaching Hospitals NHS Trust Leeds UK
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21
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Surgeons' Perspectives on Intraoperative Gray Area Surgical Complications of Cataract Surgery. J Cataract Refract Surg 2022; 48:954-960. [PMID: 35137694 DOI: 10.1097/j.jcrs.0000000000000905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 02/01/2022] [Indexed: 11/26/2022]
Abstract
PURPOSE To explore surgeons' perspectives and practice patterns in regards to "gray area" surgical complications (GASCs) within cataract surgery. SETTING Tertiary care academic referral center. DESIGN Retrospective observational cross-sectional study. METHODS An anonymous, online survey consisting of 11 potential intraoperative GASC scenarios was developed and distributed to practicing and resident ophthalmologists in the United States. Demographic data such as gender, experience and practice settings were recorded. Using a Likert scale, respondents scaled their perception of likelihood that a GASC could lead to post-operative complications, as well as their obligation towards patient disclosure and documentation in the operative report. Respondents also scaled their likelihood of agreement with a series of statements inserted to assess baseline anxiety levels and inherent perspectives regarding disclosure. RESULTS A total of 389 responses were analyzed. Female surgeons were more likely than male surgeons to disclose GASCs to their patients and experience psychological anxiety with regard to patient outcomes. Both early- and late-stage residents were more likely to believe that GASCs could lead to vision-limiting outcomes as compared to attending surgeons. Surgeons at academic centers were more likely than community-based surgeons to disclose GASCs in the operative report and experience psychological anxiety in regards to patient outcomes. CONCLUSIONS Significant differences based on gender, practice setting, and level of experience exist in regards to disclosure and documentation of intraoperative GASCs. Additional studies are needed to further explore reasons for these differences, as reporting patterns may have an impact on patient satisfaction, medico-legal risks, and postoperative surgeon-experienced anxiety.
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22
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Zur D, Loewenstein A. Is there a light at the end of the gender inequality tunnel? Clin Exp Ophthalmol 2021; 49:649-651. [PMID: 34601798 DOI: 10.1111/ceo.13998] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Dinah Zur
- Ophthalmology Division, Tel Aviv Sourasky Medical Center, affiliated to Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Anat Loewenstein
- Ophthalmology Division, Tel Aviv Sourasky Medical Center, affiliated to Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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