Gender Associated with the Intention to Choose a Medical Specialty in Medical Students: A Cross-Sectional Study in 11 Countries in Latin America

Gender Equity and Workplace Mistreatment in Oncology: Results From a Survey by the Brazilian Society of Clinical Oncology

PURPOSE

There are no available data concerning gender equity and workplace mistreatment within the field of oncology in Brazil. The Brazilian Society of Clinical Oncology (Sociedade Brasileira de Oncologia Clínica [SBOC]) performed a survey study to present and discuss this subject and gain insights into strategies that would mitigate gender inequities.

MATERIALS AND METHODS

A 24-question survey in Portuguese, assessing demographics, professional context, achievements, workplace mistreatment, parenthood, and gender balance in the workplace, was developed and administered by the SBOC Women's Leadership Committee. SBOC members were invited to participate by e-mail.

RESULTS

Among the 2,125 SBOC members, 146 women (72%) and 56 men (28%) participated in the survey. Approximately 87.5% of men versus 65.5% of women believed that they had equal rights (P < .002) at their workplace. Chiefs of oncology departments were more often men than women (30.4% v 13.7%, P < .006). Furthermore, 60.8% of men versus 85.1% of women (P = .0003) believed that a specific workplace guideline regarding gender equity should exist. Only 29.5% of women versus 98.2% of men (P < .0001) believed that they did not experience gender discrimination throughout their careers. Approximately 50% of women versus 21% of men reported experiencing moral harassment at work (P = .0002), whereas 24% of women and 7% of men reported sexual harassment (P = .005). Multivariable logistic regression confirmed the significant results of univariable analysis when adjusted for age group and holding a department chief position.

CONCLUSION

Our data show an alarming level of sexual and moral harassment and gender inequity experienced by SBOC members, highlighting the urgent need for programs to address these situations.

Gender bias in urology: The role of gender in selecting urology as a medical specialty

Background

Gender inequality has been prevalent in the history of medicine, specifically within surgical specialties. Although there have been advances, urology has remained overwhelmingly male-dominant, with slow growth in female recruitment.

Objectives

The study aimed to assess whether the gender influences selection of medical specialty, especially gender bias in urology.

Materials and Methods

A cross-sectional study was conducted among undergraduate medical students in Saudi Arabian medical schools to explore the influence of gender on urology specialty selection. Data were collected from November 2023 to June 2024 using a structured questionnaire administered electronically. A pilot study was conducted to evaluate the questionnaire's reliability and clarity. Data were analyzed using descriptive and inferential statistics. The questionnaire demonstrated acceptable reliability.

Results

The total study participants were 602 medical students. The dataset reveals a balanced gender representation, with males constituting 55.6% and females 44.4%. A substantial majority, 94.5%, expressed a definitive willingness to pursue further residency training following graduation, indicating a robust commitment to advancing their medical careers. However, while evaluating interest in urology, the statistics revealed a potential disparity, with only 43.2% affirmatively considering urology as a specialty, contrasted against 56.8% who would not. The study shows that the participants' considering urology as a specialty has a statistically significant relation to gender (P = 0.0001) as 72.3% of those who would consider the specialty were males compared to only 27.7% for females. The data also show a concerning trend where 21.8% of those uninterested in urology reported insufficient exposure during medical school as a deterrent, while others found the specialty to be embarrassing or simply uninteresting, accounting for 70.8% of the negative responses.

Conclusion

This study reveals a significant gender disparity in urology specialty selection among medical students. While the majority of students intend to pursue residency training, male students are significantly more likely to consider urology as a specialty compared to female students. Factors such as limited exposure and negative perceptions contribute to the underrepresentation of women in urology. Addressing these issues is crucial to achieving gender equality within the field.

Academic and Employment Preferences of Nursing Students at the University of Las Palmas of Gran Canaria: A Cross-Sectional Study

BACKGROUND/OBJECTIVES

It is well known that there are differences in the academic and employment preferences of nursing students once they have completed their undergraduate studies in nursing. These preferences are largely influenced by students' affinity for certain thematic areas over others. Therefore, the objective of this study was to identify the employment and academic preferences of third- and fourth-year Nursing Degree students at the University of Las Palmas de Gran Canaria (ULPGC).

METHODS

A cross-sectional, descriptive observational study was conducted among nursing students across three campuses of the ULPGC (Canary Islands, Spain). An online questionnaire was used to collect various sociodemographic and academic variables, as well as preferences across ten thematic areas. Descriptive and bivariate inferential analyses were performed, along with a correlation analysis among the areas.

RESULTS

The areas of highest preference were "Emergency Nursing", "General Nursing", and "Family and Community Nursing". The areas of lowest preference were "Other Areas (teaching, management, research)", "Mental Health and Psychiatric Nursing", and "Geriatric Nursing". Three clusters of closely correlated areas were identified: cluster 1 (Intensive and Critical Care Nursing, Emergency and Emergency Nursing and Operating Theatre and Anaesthesia Nursing), cluster 2 (Obstetric-Gynaecological Nursing-Midwifery, Paediatric Nursing and Mental Health and Psychiatric Nursing) and cluster 3 (remaining areas). A significant proportion of students expressed intentions to pursue postgraduate studies.

CONCLUSIONS

Strategies should be implemented to enhance students' preferences in the areas of "Mental Health and Psychiatric Nursing" and "Geriatric Nursing", which are areas where there is a high demand for nurses. It is also necessary to increase their interest in research, management, and teaching. This study was not registered.

Analysis of Influencing Factors for Choosing Dermatology as a Future Career: A Cross-Sectional Study Among Medical Students at King Abdulaziz University

BACKGROUND

Determining the influencing factors of choice of medical specialty is key to a balanced distribution of physicians across specialties. Dermatology, the specialty concerned with treating skin disorders, is known for being among the most wanted; however, studies identifying the factors that attract students to this specialty are lacking. Our study aimed to investigate the influencing factors of the choice of dermatology as a career in clinical-year medical students.

METHODS

We conducted a cross-sectional study with a sample of clinical-year medical students from King Abdulaziz University, Jeddah, Saudi Arabia, between 2020 and 2021. We collected data using an online self-administered questionnaire; we replicated a questionnaire present in prior research. We compared categorical data using the chi-square and Fisher's exact tests.  Results: In total, there were 252 participants, with 30 (11.9%) choosing dermatology as a specialty. Over half showed an average grade of more than 4.5 (66.7%), and 83.3% were female. The significant influencing factors of students' choice of dermatology as a career were: the likelihood of dermatologists influencing patients' lives (p=0.000), opportunities to conduct research in dermatology (P=0.000), how Dermatology allows people to have a satisfying family life (P=0.001), and opportunities for part-time work in dermatology (p=0.000).

CONCLUSION

Many factors influenced the choice of a future medical specialty in our sample. Focusing on these factors while guiding students to choose their specialty may enable a promising next generation of physicians.

The magnitude of influence of personal and professional factors on the career choices of medical students

Medical students face uncertainty in choosing their future careers, which is influenced by personal and professional factors and can have a direct impact on the healthcare system and society. In this study, we aimed to analyze the magnitude of influence of personal and professional factors on students' choices of a future specialty, among medical students in Saudi Arabia and other Arab countries. This cross-sectional exploratory study used cluster sampling and collected demographic data, influencing factors, preferred specialty, and engagement level, using a 20-item questionnaire. The study included 1,105 students, of which 60.5% were women. Income was the most influential factor for both sexes (68.5%) and was statistically significant for men (P < 0.0001), with personal experience and type of patients served being more important for women. Many students (42.6%) were undecided about their future specialty. However, general surgery was the most preferred specialty, followed by internal medicine (10.9%) and obstetrics and gynecology (5.5%). Women had a significantly higher mean personal score than men, indicating a preference for surgery (3.07 ± 2.2 vs. 2.78 ± 2.1; P = 0.029). In this study, we found that income significantly influenced medical students' choices of specialty, with surgery being the most common, and that many students are undecided about their specialty, needing career counseling and mentoring programs.

Factors Influencing Specialty and Training Center Choices Among Saudi Medical Residents

AIM

This cross-sectional study aims to identify and quantify the factors influencing Saudi medical residents in selecting their desired specialty and primary training center, while examining the associations between these factors.

METHODS

The study received approval from an institutional ethical committee at King Abdulaziz University. An electronic questionnaire was designed and validated via content, face validity, and the Content Validity Index. The sample size was calculated based on a 95% CI and a 5% margin of error. The study targeted all current residents in the current Saudi Specialty Certificate Programs. Descriptive statistics summarized demographic characteristics, training-related information, and factors influencing the selection of a specialty and training center. Fisher's exact test and Chi-square tests were employed for data analysis.

RESULTS

A total of 387 respondents completed the survey, with a 32.3% response rate. The majority of respondents were male (n = 232, 59.9%), and the majority were also married (n = 67.2%), with internal medicine (n = 92, 23.8%) and family medicine (n = 74, 19.1%) being the most prevalent specialties. Notably, 89.4% (n = 346) reported matching into their first-choice specialty, and 67.2% (n = 260) into their first-choice training center. Furthermore, 90.2% (n = 349) had prior training (elective/internship) in their chosen specialty, and 63% (n = 244) had previous training (elective/internship) at their primary training center. Prior exposure to both specialty and center significantly resulted in them being the resident's top choice (p < 0.01). Multiple factors influencing the choice of either the specialty or the center were found to have statistically significant associations with the gender, specialty, residency level, sector of the training center, and timing of the specialty decision (p < 0.05).

CONCLUSION

This study reveals the substantial influence of early experiences on Saudi medical residents' specialty and training center choices. It also uncovers gender disparities and variations in the influence of specialty-related factors. Future research with larger and more diverse samples is recommended to gain a deeper understanding of the multifactorial decision-making processes, enabling the development of strategies to better meet the evolving needs and preferences of healthcare professionals in Saudi Arabia.

Australian medical students' and junior doctors' perceptions of gender discrepancies in obstetrics and gynaecology

BACKGROUND

There is currently a gender imbalance 85:15 female/male in the intake into specialist training for the Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG).

AIMS

To determine the views and perceptions of Australian medical students, and junior doctors in the first five years of practice, toward obstetrics and gynaecology (O&G) as a career, including whether there are any perceived barriers to the pursuit of such a career.

MATERIALS AND METHODS

A semi-structured questionnaire was developed with members of the RANZCOG Gender Equity and Diversity Working Group There were two separate studies: the first involved telephone interviews of medical students across three campuses of a medical school in North Queensland. The second study surveyed junior doctors in Queensland who are members of the Australian Medical Association. Responses were analysed and compared using quantitative and qualitative methods.

RESULTS

Both studies found that experiences with O&G as a medical student influenced the decision to pursue O&G as a career. Exclusion from clinical scenarios and difficulty establishing good relationship with midwives within busy birthing suites were some reasons deterring male students from O&G. In addition, students felt poorly informed about the specialty in their preclinical years, affecting their early decisions in choice of specialty. Post-rotation, more female than male students reported positive experiences and were considering O&G as a career.

CONCLUSIONS

Both groups see medical student experience as critical in attitudes toward the specialty as a possible career. This experience plays a significant role in encouraging female students toward a career in O&G and discouraging male students. More exposure to the specialty in the preclinical years, and attention to improving clinical rotations for all students, is required.

House officers' specialist career choices and motivators for their choice- a sequential mixed-methods study from Malaysia

PURPOSE

Shortage and maldistribution of medical specialists hamper healthcare quality. The specialist career choices of house officers determines the future composition of healthcare systems. We studied house officers'' specialist career choices and motivators for their choice.

PARTICIPANTS AND METHODS

We conducted online in-depth interviews among seven house officers using an interview guide developed based on a literature review. The transcripts were analyzed. Major themes were identified. A 33-item questionnaire was developed, and the main and sub-themes were identified as motivators for specialist career choice. An online survey was done among 185 house officers. Content validation of motivators for specialist choice was done using exploratory factor analysis. First, second and third choices for a specialist career were identified. Multinomial logistic regression analyses were done to determine the socio-demographic factors and motivators associated with the first choice.

RESULTS

HOs perceived that specialist training opportunities provide a wide range of clinical competencies through well-structured, comprehensive training programs under existing specialist training pathways. Main challenges were limited local specialist training opportunities and hurdles for 'on-contract' HO to pursue specialist training. Motivators for first-choice specialty were related to 'work schedule', 'patient care characteristics', 'specialty characteristics', 'personal factors', 'past work experience', 'training factors', and 'career prospects.' House officers' first choices were specialties related to medicine (40.5%), surgery (31.5%), primary care (14.6%), and acute care (13.5%). On multivariate analysis, "younger age", "health professional in the family", "work schedule and personal factors", "career prospects" and "specialty characteristics" were associated with the first choice.

CONCLUSIONS

Medical and surgical disciplines were the most preferred disciplines and their motivators varied by individual discipline. Overall work experiences and career prospects were the most important motivators for the first-choice specialty. The information about motivational factors is helpful to develop policies to encourage more doctors to choose specialties with a shortage of doctors and to provide career specialty guidance.

Redefining the Gender Gap in Urology Authorship: An 18-Year Publication Analysis

BACKGROUND

Academic authorship is a critical productivity metric used for academic promotion.

OBJECTIVE

To characterize temporal changes in female representation in academic authorship in ten primary urology journals as the complement of female urologists is increasing.

DESIGN, SETTING, AND PARTICIPANTS

Publication records were retrieved from 2002 to 2020 for the ten urology journals with the highest impact factor. The names of all authors were gathered and gender was inferred using first names.

OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS

Trends in first and last/senior authorship by gender were evaluated overall, within journals, and by geographic region.

RESULTS

A total of 59,375 articles were analyzed, of which 94.1% had gender information for the first author and 94.2% had gender information for the last author. The percentage of overall female authors increased positively from 17.2% (95% highest density interval [HDI] 12.9-21.4%) in 2002 to 27.2% (HDI 21.7-33.6%; p < 0.01) in 2020. Overall female first authorship increased from 15.2% (95% HDI 11.0-19.5%) to 28.5% (95% HDI 21.8-35.6%; p < 0.01). There was also significant growth for female senior authors from 10.4% (95% HDI 7.6-13.5%) to 18.6% (95% HDI 13.6-23.8%; p < 0.01). Assessment of journal-specific changes revealed that Neurourology and Urodynamics (12.6%, 95% HDI 9.9-15.1%) and The Journal of Sexual Medicine (16.2%, 95% HDI 13.6-19.0%) had significantly higher growth in female authorship when compared to Journal of Endourology (7.2%, 95% HDI 5.5-8.7%) and Urologic Oncology (4.5%, 95% HDI 2.0-6.8%; p < 0.05).

CONCLUSIONS

Although overall female authorship increased between 2002 and 2020, women remain underrepresented in urology authorship. The percentage of females in senior (last) author positions is less than the percentage of females in first author positions. Journal-specific differences can probably be attributed to gender-based differences in subspecialized fields.

PATIENT SUMMARY

In this study, we characterized the underrepresentation of women as authors in urology journals and analyzed the change in female authorship for ten academic urology journals over the course of 18 years. Although the proportion of female authors has increased over that time, the percentage of females in senior authorship roles is less than the percentage of females in first author positions.

Is Urology a gender-biased career choice? A survey-based study of the Italian medical students' perception of specialties

Background

Despite the well-established worldwide phenomenon of “the feminisation of medicine,” in Italy, Urology remains a male-dominated field.

Objective

The aims of our work are to assess data on medical students' choice of surgical specialty in Italy to investigate if a gender-biased trend exists and to find the key points that influence the decision-making process when choosing a specialty, with a focus on Urology.

Design

Data about access to residency programs in 2017–2020 were analysed through descriptive statistics. Investigations concerning the decision-making process were carried through distribution of an online anonymous survey to Italian medical students.

Results

Urology was among the specialties with the lowest proportion of female residents in Italy in the last 4 years: 37 (29.4%) in 2017, 27 (21.4%) in 2018, 40 (26.7%) in 2019, and 57 (25.2%) in 2020. The total number of participants of the survey was 1409, of which only 341 declared being keen to pursue a career path in surgery. Out of the 942 students not interested in surgery, 46.2% females and 22.5% males indicated a “sexist environment” as one of the reasons. Overall, the main reason for medical students not choosing Urology is the lack of interest in the specialty. Furthermore, there is a different perception of Urology as a sexist environment between female (23.4%) and male (3.2%, p < 0.001) medical students, which may influence their decision-making process.

Conclusions

In Italy, the prevalence of female medical graduates does not mirror the proportion of female doctors choosing a career in some surgical specialties, including Urology. Our survey results clearly identified that a large proportion of medical graduates are not choosing urology because of the perception of a sexist environment. While the reasons for this phenomenon remain unclear, the presence of a gender-biased perception of a sexist environment represents a possible explanation.

Role of Female Research at the Asociacion Mexicana de Cirugia General Annual Meeting: A Retrospective Analysis From 2013 to 2019

Background

Academic surgery has been a traditionally male-dominated field. Female contribution remains challenging. In Mexico, there is no published evidence regarding gender disparity in academic surgery. We aimed to analyze the female role in clinical research submitted to the Asociación Mexicana de Cirugía General (AMCG).

Methods

Retrospective study evaluating abstracts submitted to AMCG annual meetings from 2013 to 2019. Categorical variables were compared using χ² test. Univariate logistic regression was performed to calculate odds ratios (OR) followed by a log-binomial logistic regression model to obtain the adjusted relative risk (aRR) for acceptance as an oral presentation.

Results

Overall, 7,439 abstracts were analyzed of which 24.2% were submitted by females. Female-submitted abstracts increased from 22.5% to 25.3% during 2013–2019 (p = 0.15). The proportion of 47 abstracts submitted by females was higher in the resident group (27.7% vs. 18.8%; p < 0.001). The percentage of females’ abstracts selected for oral presentation was less than the percentage of males’ 49 abstracts selected for presentation (9% vs. 11.5%; p = 0.002). Females’ abstracts submitted have a 50 23.5% decreased chance of being selected for oral presentation (OR = 0.765, CI 95%, 0.639–0.917, 51 p = 0.003). However, after adjusting for research type and trainee status, the gender of the oral 52 presenting author showed no association (aRR = 0.95, CI 95%, 0.8–1.1, p = 0.56).

Conclusion

In Mexico, the female role in academic surgery is still limited. These results should 55 encourage professors and program directors to identify and address factors contributing to gender 56 disparities.

The feminization of medicine in Latin America: 'More-the-merrier' will not beget gender equity or strengthen health systems

This viewpoint addresses the lack of gender diversity in medical leadership in Latin America and the gap in evidence on gender dimensions of the health workforce. While Latin America has experienced a dramatic change in the gender demographic of the medical field, the health sector employment pipeline is rife with entrenched and systemic gender inequities that continue to perpetuate a devaluation of women; ultimately resulting in an under-representation of women in medical leadership. Using data available in the public domain, we describe and critique the trajectory of women in medicine and characterize the magnitude of gender inequity in health system leadership over time and across the region, drawing on historical data from Mexico as an illustrative case. We propose recommendations that stand to disrupt the status quo to more appropriately value women and their representation at the highest levels of decision making for health. We call for adequate measurement of equity in medical leadership as a matter of national, regional, and global priority and propose the establishment of a regional observatory to monitor and evaluate meaningful progress towards gender parity in the health sector as well as in medical leadership.

Impact of COVID-19 on residency choice: A survey of New York City medical students

OBJECTIVES

The Coronavirus disease 2019 (COVID-19) pandemic disrupted medical student education, particularly in New York City (NYC). We aimed to assess the impact of the COVID-19 pandemic on medical students' residency choices.

METHODS

The authors conducted a cross-sectional survey of medical students in all years of study at four NYC medical schools (Columbia, Cornell, NYU, and SUNY Downstate). The survey was fielded from 19 Aug 2020 to 21 Sep 2020. Survey questions included items assessing COVID-19 impact on residency choices, personal impact of COVID-19, residency/specialty choices, and factors influencing these choices.

RESULTS

A total of 2310 students received the survey, with 547 (23.7%) providing partial responses and 212 (9.2%) providing valid responses for our primary analysis. 59.0% of participants thought that COVID-19 influenced their choice of residency/specialty, with 0.9% saying the influence was to a great extent, 22.2% to some extent, and 35.8% very little. On multivariable analysis, factors that were independently associated with COVID-19 impacting residency choice included low debt ($1 to $99,999: adjOR 2.23, 95%CI 1.02-5.03) compared with no debt and Other race/ethnicity (adjOR 0.26, 95%CI 0.10-0.63) compared with White race/ethnicity. On secondary analysis of all participants answering survey items for logistic regression regardless of survey completion, direct personal impact of COVID-19 was significantly associated with COVID-19 impacting specialty choice (adjOR 1.90, 95%CI 1.04-3.52). Moreover, 24 students (11.6%) reported a change in their top residency choice from before to during/after COVID-19, citing concerns about frontline work, work-life balance, and risk of harm.

CONCLUSIONS

Our study found that 3 in 5 (59.0%) participants felt that COVID-19 impacted their residency choice, with 11.6% of respondents explicitly changing their top specialty choice. Investigating the impact of the pandemic on medical student residency considerations is crucial to understand how medical career outlooks may change in the future.

Gender Differences and Influencing Factors in Specialty Choices: Findings From One Medical School in China

Background: Gender plays a significant role in the selection of medical specialty. Few studies have been conducted to explore the impact of gender differences on specialty choosing among Chinese medical students.

Methods: The specialty choices of 648 students from six consecutive classes in an 8-year MD program were collected and compared between male and female students. A total of 110 students from one graduating class were surveyed by a questionnaire covering 22 career influencing factors. Each factor has a scale of zero to three (zero = no influence, one = mild influence, two = moderate influence, and three = strong influence).

Results: Statistically significant gender differences were observed in 10 out of 16 specialties. Most male students limited their specialty choices to surgery (64%), internal medicine (12%), and orthopedics (12%), compared with a relatively diversified pattern in female students. For male students, the top three influencing factors were personal interest, future job prospects for the chosen specialty, and job opportunity in academic medicine. The strongest influencing factors of females were personal interest, specialty-specific knowledge and skills, and the sense of achievement. The expected salary was ranked among the top 10 influencing factors in male but not in females, while the work-life balance was ranked among the top 10 factors in females but not in males.

Conclusion: There is a significant gender difference regarding specialty choices among Chinese medical students. Career coaching is needed to help students in their specialty choosing process.

Analysis of Gender Disparity in US and Canadian Radiology Residency Programs

BACKGROUND

Equity, diversity, and inclusion in academic radiology are a work in progress and although the gender gap has decreased, there remains a paucity of studies examining female representation among radiology trainees over the past decade.

OBJECTIVE

The aim of our undertaking was to evaluate gender parity in United States (US) and Canadian radiology residency programs and to suggest future directions to improve female representation MATERIALS AND METHODS: Retrospective analysis of publicly available data on radiology residents from the US and Canada was performed from 2007to 2019. Data on diagnostic radiology residents was collected from the Accreditation Council for Graduate Medical Education for the US and the Canadian Post M.D. Education Registry for Canada. Statistical tests including regression and ANOVA were used to study the gender proportions from 2007to 2019.

RESULTS

There has been little progress in bridging the gender gap in the last 12 years. The proportion of female residents pursuing radiology has remained at an average of 26.74% (n = 1,238of 4,629) in US programs and 31.78% (n = 28 of88) in Canadian programs. The average change in the percentage of female residents was 0.0% per year (P = 0.0) for US programs and -2.9% per year (P = 0.3) for Canadian programs.

DISCUSSION

Despite a higher proportion of females in North American medical schools, gender disparity persists among radiology residents. More research is needed to identify barriers limiting female representation and improve gender parity across North American radiology programs.

Analysis of Authorship in Hepatopancreaticobiliary Surgery: Women Remain Underrepresented

INTRODUCTION

Given the need to increase female representation in hepatopancreatobiliary (HPB) surgery, as well as the need to increase the academic pipeline of women in this subspecialty, we sought to characterize the prevalence of female authorship in the HPB literature. In particular, the objective of the current study was to determine the proportion of women who published HPB research articles as first, second, or last author over the last decade.

METHODS

All articles pertaining to hepatopancreaticobiliary (HPB) surgery appearing in seven surgical journals (Annals of Surgery, British Journal of Surgery, JAMA Surgery, Annals of Surgical Oncology, HPB (Oxford), Surgery, and Journal of Gastrointestinal Surgery) were reviewed for the years 2008 and 2018. Information on sex of author, country of author's institution, and article type was collected and entered into a computerized database.

RESULTS

Among the 1473 index articles included in the final analytic cohort, 414 (28%) publications had a woman as the first or last author, while the vast majority (n = 1,059, 72%) had a man as the first or last author. The number of female first authors increased from 15.6% (n = 92/591) in 2008 to 25.7% (n = 227/882) in 2018 (p < 0.001). There were no differences in the proportion of second (n = 123/536, 23.0% vs n = 214/869, 24.6%, p = 0.47) or last (n = 44/564, 7.8% vs n = 88/875, 10.1%, p = 0.15) authors. Women were more likely to publish papers appearing in medium-impact journals (OR 1.40, 95% CI 1.04-1.88) and articles with a female author were more likely to be from a North American institution (referent: North America, Asia OR 0.43, 95% CI 0.31-0.59 vs Europe OR 0.67, 95% CI 0.51-0.87).

CONCLUSION

Women first/last authors in HPB research articles have increased over the past 10 years from 22 to 32%. Women as last authors remain low, however, as only 1 in 10 papers had a senior woman author. These data should prompt HPB leaders to find solutions to the gap in female authorship including mentorship of young female researchers and surgeons.

Sex-Based Disparities in the Hourly Earnings of Surgeons in the Fee-for-Service System in Ontario, Canada

Importance

Sex-based income disparities are well documented in medicine and most pronounced in surgery. These disparities are commonly attributed to differences in hours worked. One proposed solution to close the earnings gap is a fee-for-service payment system, which is theoretically free of bias. However, it is unclear whether a sex-based earnings gap persists in a fee-for-service system when earnings are measured on the basis of hours worked.

Objective

To determine whether male and female surgeons have similar earnings for each hour spent operating in a fee-for-service system.

Design, Setting, and Participants

This cross-sectional, population-based study used administrative databases from a fee-for-service, single-payer health system in Ontario, Canada. Surgeons who submitted claims for surgical procedures performed between January 1, 2014, and December 31, 2016, were included. Data analysis took place from February 2018 to December 2018.

Exposures

Surgeon sex.

Main Outcomes and Measures

This study compared earnings per hour spent operating between male and female surgeons and earnings stratified by surgical specialty in a matched analysis. We explored factors potentially associated with earnings disparities, including differences in procedure duration and type between male and female surgeons and hourly earnings for procedures performed primarily on male vs female patients.

Results

We identified 1 508 471 surgical procedures claimed by 3275 surgeons. Female surgeons had practiced fewer years than male surgeons (median [interquartile range], 8.4 [2.9-16.6] vs 14.7 [5.9-25.7] years; P < .001), and the largest proportion of female surgeons practiced gynecology (400 of 819 female surgeons [48.8%]). Hourly earnings for female surgeons were 24% lower than for male surgeons (relative rate, 0.76 [95% CI, 0.74-0.79]; P < .001). This disparity persisted after adjusting for specialty and in matched analysis stratified by specialty, with the largest mean differences in cardiothoracic surgery (in US dollars: $59.64/hour) and orthopedic surgery ($55.45/hour). There were no differences in time taken by male and female surgeons to perform common procedures; however, female surgeons more commonly performed procedures with the lowest hourly earnings.

Conclusions and Relevance

Even within a fee-for-service system, male and female surgeons do not have equal earnings for equal hours spent working, suggesting that the opportunity to perform the most lucrative surgical procedures is greater for men than women. These findings call for a comprehensive analysis of drivers of sex-based earning disparities, including referral patterns, and highlight the need for systems-level solutions.

Socio-economic characteristics and career intentions of the WiSDOM health professional cohort in South Africa

Background

The human resources for health (HRH) crisis and dearth of research on the health labour market in South Africa informed the WiSDOM (Wits longitudinal Study to Determine the Operation of the labour Market among its health professional graduates) cohort study. The study aims to generate new knowledge on the career choices and job location decisions of health professionals in South Africa.

Methods

WiSDOM is a prospective longitudinal cohort study. During 2017, the first cohort for each of eight professional groups was established: clinical associates, dentists, doctors, nurses, occupational therapists, oral hygienists, pharmacists and physiotherapists. These cohorts will be followed up for 15 years. For the baseline data collection, each final year health professional student completed an electronic self-administered questionnaire (SAQ), after providing informed consent. The SAQ included information on: demographic characteristics; financing of training; reasons for choosing their profession; and their career intentions. We used STATA^® 14 to analyse the data.

Results

We obtained an 89.5% response rate and 511 final year health professional students completed the baseline survey. The mean age of all participants was 24.1 years; 13.1% were born in a rural area; 11.9% and 8.0% completed their primary and secondary schooling in a rural area respectively. The health professional students came from relatively privileged backgrounds: 45.0% had attended a private school, the majority of their fathers (77.1%) had completed tertiary education, and 69.1% of their mothers had completed tertiary education. Students with higher socio-economic status (SES Quintiles 3–5) made up a larger proportion of the occupational therapists (77.8%), physiotherapists (71.7%), doctors (66.7%), and dentists (64.7%). In contrast, individuals from SES Quintiles 1 and 2 were over-represented among the clinical associates (75.0%), oral hygienists (71.4%), nurses (61.9%), and pharmacists (56.9%). Almost one quarter (24.9%) of cohort members indicated that they had partly financed their studies through loans. Although 86.3% of all cohort members indicated that they plan to stay in their chosen profession, this ranged from 43.2% for clinical associates to 100% for dentists.

Conclusions

WiSDOM has generated new knowledge on health professional graduates of a leading South African University. The results have implications for university selection criteria and national health workforce planning.

Career Choices and Career Progression of Junior Doctors in Dermatology: Surveys of UK Medical Graduates

Objective

To report UK-trained doctors' career choices for dermatology, career destinations, and factors influencing career pathways.

Methods

Multicohort multipurpose longitudinal surveys of UK-trained doctors who graduated between 1974 and 2015.

Results

In all, 40,412 doctors (58% of graduates) responded in year 1, 31,466 (64%) in year 3, and 24,970 (67%) in year 5. One year after graduation, 1.7% of women and 0.6% of men made dermatology their first choice but by five years after graduation the respective figures were 1.0% and 0.7%. Compared to their predecessors, its popularity fell more substantially from years 1 to 5 among recent graduates (2005–15), particularly for women (from 2.1% in year 1 to 0.8% in year 5) compared with a fall from 0.8% to 0.5% among men. The most important factor influencing dermatology choice was “hours/working conditions”: in year one, 69% regarded this as important compared with 31% of those choosing other hospital physician specialties. Only 18% of respondents who chose dermatology at year 1 eventually worked in it; however, almost all practising dermatologists (94%), 10 years after qualifying, had made their future career decision by year 5.

Conclusion

Dermatology is popular among female UK graduates. Most dermatologists made their career decision late but decisively.

Medical student researchers in Colombia and associated factors with publication: a cross-sectional study

BACKGROUND

Gaps between evidence-based research and clinical-public health practice have been evident for decades. One of the aims of medical student research is to close this gap. Accordingly, evaluating individual and environmental factors that influence participation of medical students in research are needed to understand and identify potential targets for action. This study aims to identify characteristics of medical student researchers in Colombia and the associated factors with scientific publications.

METHODS

A cross-sectional study of Colombian medical students involved in research using a validated, self-administered, online survey. The survey was distributed through the Colombian Association of Medical Students' Associations (ASCEMCOL). Data sets were analyzed using descriptive and summary statistics. Bivariate analysis and a multiple logistic regression model were conducted to identify predictors of scientific publications.

RESULTS

A total of 133 responses were analyzed from students at 12 Colombian cities and 20 higher-education institutions. Although 94% of responders had at least one research proposal, only 57% had completed a project, and 17% had published their findings. Barriers for undertaking research included time restrictions and a lack of mentorship. Motivational factors included opportunity to publish findings and good mentorship. Students planning to do a specialization (OR = 3.25; 95% Confidence interval [CI] = 1.27-8.30), innovators (OR = 3.52; 95%CI = 1.30-9.52) and committed (OR = 3.39; 95%CI = 1.02-11.29), those who had previously published their findings (OR 9.13 IC95% 2.57-32.48), and were further in their medical education (OR 2.26 IC95% 1.01-5.07), were more likely to publish scientific papers.

CONCLUSIONS

Our findings describe medical students understanding of the process of conducting research in Colombia. Although there appears to be motivation to participate in research, very few students achieve publication. Barriers such as time constraints and mentorship seem to play a critical role. This highlights opportunities where barriers to research can be overcome in medical school and other levels.