Gender distribution and leadership trends in trauma surgery societies

Gender Disparity in Academic Trauma Surgery: The Current State of Affairs

INTRODUCTION

Despite the increasing number of female surgeons in general surgery programs, women are still inadequately represented in leadership positions. This study aims to investigate the magnitude of gender bias in university-based trauma surgery fellowship programs and leadership positions in the United States of America.

MATERIAL AND METHODS

FRIEDA was used to identify trauma surgery programs. A thorough website review of each program obtained further information on faculty members, including their name, age, gender, and faculty rank. Trauma surgeons with an MD or DO qualification and a faculty rank of Professor, Associate Professor, or Assistant Professor were selected for inclusion in this study. SCOPUS was used to assess the H-index and the number of publications and citations of surgeons.

RESULTS

The total number of programs included was 136, consisting of 715 faculty members. Less than a quarter (n = 166; 23.2%) comprised females and less than one-fifth (n = 30; 19%) of female surgeons were Professors. The difference in the research productivity of male and female trauma surgeons was statistically significant (P < .05), with the average H-index being 10 vs 7.5, respectively, amongst the top 50 surgeons of both genders. Based on a multiple regression analysis, academic rank was significantly associated (P < .05), and gender was not significantly associated (P > .05) with H-index.

CONCLUSION

Gender disparity exists in the field of trauma surgery, as noted in senior faculty ranks and leadership positions. Female-inclusive state policies, appropriate mentorship, and supportive institutions can help to bridge this gap.

Women in urology: what is their current situation in Spain?

OBJECTIVE

To analyze the current state of women in urology in Spain.

MATERIAL AND METHODS

Descriptive study based on the results of an online survey sent between February and April 2020 through the database of the Residents and Young Urologists group (RAEU) of the Spanish Association of Urology (AEU). Characteristics of the survey and its results were analyzed.

RESULTS

In total, 257 responses were obtained from 210 women (81.71%) and 47 men (18.29%) belonging to 111 hospitals. Statistically significant differences were observed (p < 0.001) with a higher proportion of men in all categories except for the group of young female and male attendings (29-39 years, p = 0.789), and the group of female residents against male residents (p = 0.814). The number of men was higher in hospitals with subspecialty units except for the Pelvic Floor Unit, where no statistically significant difference was observed (p = 0.06). Regarding positions of responsibility, only 7 out of 111 hospitals had female Department Chiefs.

CONCLUSIONS

Women's representation in urology is increasing, mainly due to the younger generations. However, the access of these women to relevant positions is anecdotal.

Breaking barriers and advancing diversity, equity, and inclusion in trauma and acute care surgery: A current perspective

ABSTRACT

The importance of diversity, equity, and inclusion (DEI) in trauma and acute care surgery (ACS) has become increasingly apparent in the field of medicine. Despite the growing diversity of the patient population, the surgical specialty has traditionally been dominated by White males. This involves increasing the representation of diverse individuals in leadership positions, professional societies, scholarships, graduate education, and practicing physicians. This opinion piece aims to address the gaps in the literature regarding DEI in trauma and acute care surgery and highlight the issues related to the workforce, gender gap, patient outcomes, and health services. To effectively guide DEI interventions, it is essential to capture patient-reported experience data and stratify outcomes by factors including race, ethnicity, ancestry, language, sexual orientation, and gender identity. Only then can generalizable findings effectively inform DEI strategies. Using validated measurement tools, it is essential to conduct these assessments with methodological rigor. Collaboration between health care institutions can also provide valuable insights into effective and ineffective intervention practices through information exchange and constructive feedback. These recommendations aim to address the multifactorial nature of health care inequities in trauma and ACS. However, successful DEI interventions require a deeper understanding of the underlying mechanisms driving observed disparities, necessitating further research.

LEVEL OF EVIDENCE

Level V.

And Miles to Go Before We Sleep: EAST Diversity and Inclusivity Progress and Remaining Challenges

OBJECTIVE

The aim of this study was to examine the diversity, equity, and inclusion landscape in academic trauma surgery and the EAST organization.

SUMMARY BACKGROUND DATA

In 2019, the Eastern Association for the Surgery of Trauma (EAST) surveyed its members on equity and inclusion in the #EAST4ALL survey and assessed leadership representation. We hypothesized that women and surgeons of color (SOC) are underrepresented as EAST members and leaders.

METHODS

Survey responses were analyzed post-hoc for representation of females and SOC in academic appointments and leadership, EAST committees, and the EAST board, and compared to the overall respondent cohort. EAST membership and board demographics were compared to demographic data from the Association of American Medical Colleges.

RESULTS

Of 306 respondents, 37.4% identified as female and 23.5% as SOC. There were no significant differences in female and SOC representation in academic appointments and EAST committees compared to their male and white counterparts. In academic leadership, females were underrepresented ( P < 0.0001), whereas SOC were not ( P = 0.08). Both females and SOC were underrepresented in EAST board membership ( P = 0.002 and P = 0.043, respectively). Of EAST's 33 presidents, 3 have been white women (9%), 2 have been Black, non-African American men (6%), and 28 (85%) have been white men. When compared to 2017 AAMC data, women are well-represented in EAST's 2020 membership ( P < 0.0001) and proportionally represented on EAST's 2019-2020 board ( P > 0.05).

CONCLUSIONS

The #EAST4ALL survey suggests that women and SOC may be underrepresented as leaders in academic trauma surgery. However, lack of high-quality demographic data makes evaluating representation of structurally marginalized groups challenging. National trauma organizations should elicit data from their members to re-assess and promote the diversity landscape in trauma surgery.

Leadership Diversity in the Association of Program Directors in Surgery: A Report of Progress

BACKGROUND

Across the last several years, numerous surgical departments and societies have focused on addressing the lack of diversity, equity, and inclusion (DEI) in the field. Since the Association of Program Directors in Surgery (APDS) Diversity and Inclusion Taskforce was created in 2017 (and solidified as a formal committee in 2018, herein referred to as the APDS-DIC), it has sought to address gaps in diversity at various phases of training and development from medical student to surgical leader.

OBJECTIVE

In follow-up to a 2018 study that benchmarked leadership demographics of the APDS, this study analyzed how the APDS' efforts have aligned with recommended DEI strategies and whether this produced demographic changes in organizational leadership.

METHODS

Fifteen years (2008-2022) of publicly available APDS annual meeting program data and APDS membership lists were analyzed. Leadership positions in the organization were examined by officer, program/vice chair, executive committee, and board of directors. A 2-tailed T-test compared differences in the average proportion of leaders from specific demographic groups before and after the APDS-DIC inception (2008-2016 vs. 2017-2022).

RESULTS

APDS has 724 unique faculty and 140 resident members. The majority of both groups identified as White (68% of faculty and 58% of residents). Over 15 years, there have been 307 available leadership positions held by 67 individuals. All presidents and president-elect positions have been held by White surgeons; nearly 80% have been men. The average proportion of female leaders and the average proportion of racial/ethnic minority leaders were both significantly higher after implementation of the APDS-DIC in 2017 (p=0.0009 for gender and p=0.036 for racial/ethnic minorities).

CONCLUSIONS

The APDS' commitment to DEI efforts and establishment of the APDS-DIC in 2017 was associated with a significant increase in women and non-White minorities in organizational leadership positions. The specific role of the APDS-DIC in propelling surgeons from underrepresented groups into leadership and promoting key DEI efforts is broadly applicable to other surgical organizations.

The choices we make: Ethical challenges in trauma surgery

BACKGROUND

Ethical issues in trauma surgery are commonplace but scarcely studied. We aim to characterize the ethical dilemmas trauma surgeons encounter in clinical practice and describe perceptions about the ability to manage these dilemmas and strategies they use to address them.

METHODS

Members of a U.S. trauma society were electronically surveyed on handling ethically challenging scenarios. The survey instrument was developed using published ethics literature and iterative cognitive interviews. Domains included perceived frequency of encountering and self-efficacy of managing ethical situations in trauma surgery. Common situations were defined as those encountered monthly or weekly. Ethical problems were categorized within 7 larger categories: general ethics, autonomy, communication, justice, end-of-life, conflict, and other. Descriptive analyses were performed; group comparisons were analyzed using analysis of variance.

RESULTS

Of 1,748 surveyed, 548 responded (30.6%) and 154 (28%) were female. Most were White, under 55 years age, had completed fellowship training, and were practicing at a level I or II trauma center. The most encountered ethical categories were generic ethics and communication (79%). Issues involving conflict were least frequent (21%). Respondents felt most uncomfortable with autonomy topics. Respondents with high self-efficacy in handling ethical situations were older, in practice ≥15 years, served on an ethics committee, and/or frequently experienced ethical challenges.

CONCLUSION

Most trauma surgeons regularly encounter ethical challenges, especially those related to communication. Trauma surgeons encounter ethical issues involving conflict least often, and lowest self-efficacy scores with issues involving autonomy. Experienced trauma surgeons reported higher self-efficacy scores in managing ethical issues. Future work should examine how self-efficacy translates to observed behavior, and how trauma surgeons build and enhance their ethical skillsets in the care of the injured patient.

The glass podium: Gender representation within the American Association of Endocrine Surgeons (AAES) from 2010 to 2019

BACKGROUND

Despite increasing numbers of women in surgery, female underrepresentation in surgical societies remains an ongoing issue. We sought to determine the gender composition of presenters at the American Association of Endocrine Surgery annual meetings.

METHODS

Utilizing previous meeting data, we collected gender information for presenters from 2010 to 2019, including first/senior author combinations. Awards winners and invited lecturers were also reviewed. We performed binomial testing to analyze proportions of male to female presenters, with significance set at P < .05. Temporal trends were analyzed via linear regression.

RESULTS

Fifty-six percent of American Association of Endocrine Surgery fellows and 36% of members are female. Of 354 podium and 477 poster presentations, women were listed less often as first (42.7%, P = .007) and senior (30.6%, P < .0001) podium authors and less often as first (42.8%, P = .002) and senior (29.8%, P < .0001) poster authors. The most common combination of first/senior authors was male-male (43.1%), followed by female-male (26.8%), female-female (16.1%), and male-female (14.0%). Less than 15% of invited lecturers were women, and women represented a minority in nearly all award categories. We observed a positive trend in female first authorship over time (slope = 0.766, 95% confidence interval, 0.70%-2.23%, P = .26) but no change in female senior authorship over time (slope = 0.03348, 95% confidence interval, 1.086%-1.153%, P = .95).

CONCLUSION

Women are underrepresented as American Association of Endocrine Surgery presenters and less likely to receive awards or deliver invited lectures. Although female first authorship increased over time, women continued to lag behind men as senior authors and mentors to trainees and junior faculty. Opportunities to improve speaker and awardee representation should be explored.

The Biology and Psychology of Surgical Learning

Surgical education requires proficiency with multiple types of learning to create capable surgeons. This article reviews a conceptual framework of learning that starts with the biological basis of learning and how neural networks encode memory. We then focus on how information can be absorbed, organized, and recalled, discussing concepts such as cognitive load, knowledge retrieval, and adult learning. Influences on memory and learning such as stress, sleep, and unconscious bias are explored. This overview of the biological and psychological aspects to learning provides a foundation for the articles to follow.