Factors affecting interest in orthopedics among female medical students: a prospective analysis

Female Physicians Leading Health Care in the Arab World

BACKGROUND AND OBJECTIVES

A global trend in female leadership roles in the medical profession is on the rise, and females have been taking up leadership roles in varying and increasing levels. This study aims to identify changes in trends in the medical field in terms of gender in the last decade in Kuwait.

METHODS

A case study was conducted, in which data on leadership positions in Kuwait's government hospitals were obtained from hospital registries. Demographic data about female to male physicians were collected from statistics published by the Department of Manpower, Statistics and Planning of Kuwait's Ministry of Health. In addition, statistics on medical graduates were obtained from the Faculty of Medicine (FOM), Kuwait University (KU).

RESULTS

In general, every government hospital in Kuwait has experienced an increase in leadership roles among females; in 2008, among all leadership positions in Kuwait's general hospitals, males occupied a majority of positions (60%); whereas in 2016, the male to female ratio was 1:1. The most change in gender trends was witnessed at Mubarak Al-Kabeer Hospital, where female leaders went from 38% in 2008 to 73% in 2016. The specialties that have the highest number of females in leadership positions across all hospitals from 2008 to 2016 were nuclear medicine, radiology, and laboratory medicine. In KU's FOM, female graduates outweighed male graduates, except in 2005-2006, where females reached a minimum of 48%. The number of female physicians has also increased from its lowest of 31% of the total number of physicians in 2004-2006, to 37% in 2015.

CONCLUSION

While women make up more than half of medical graduates in Kuwait at present, significant barriers had restricted their entry into formal medical leadership roles in the past. However, it is now seen that females currently occupy more leadership positions in government hospitals in Kuwait.

Women in Orthopaedic Surgery: Population Trends in Trainees and Practicing Surgeons

BACKGROUND

American medical schools have gradually achieved balance in the sex of medical graduates over the past 4 decades. However, orthopaedic surgery has remained disproportionately male-dominated. Our aim was to quantify this discrepancy across surgical specialties at the residency training and academic faculty levels. We additionally sought to evaluate the prevalence of women in orthopaedic subspecialty and research societies.

METHODS

Publicly available data from the Association of American Medical Colleges (AAMC) and the Accreditation Council for Graduate Medical Education (ACGME) for the 2005-2006 to 2016-2017 academic years were pooled for analysis of sex in surgical residency programs. The AAMC 2016 Faculty Roster provided data on the sex composition of academic medical faculty, including rank. Current subspecialty and research society membership demographic characteristics were obtained by directly contacting each group.

RESULTS

Female orthopaedic surgery residents represented 0.92% of all female medical residents in the 2016-2017 academic year. Orthopaedic surgery remains the medical specialty with the lowest proportion of female residents at 14.0% in the 2016-2017 academic year, up from 11.0% in the 2005-2006 academic year. The percentage increase over this time period (27.3%) lags behind other male-dominated fields such as neurological surgery (56.8%) and thoracic surgery (111.2%). Women account for 17.8% of full-time orthopaedic surgery faculty at American medical schools, lower than all other medical specialties. In the 2015-2016 academic year, 1 orthopaedic surgery department chair and only 8.7% of professors of orthopaedic surgery were female. Women make up 6.5% of the American Academy of Orthopaedic Surgeons (AAOS) membership. The specialty societies with the fewest women are The Knee Society (0.5%), The Hip Society (0.6%), and the Cervical Spine Research Society (1.5%).

CONCLUSIONS

Orthopaedic surgery's slow increase in the number of female residents and academic faculty lags behind that of other specialties. The lack of female orthopaedic surgeons in higher ranks within medical schools is detrimental to recruitment of female medical students to the field. Further efforts should be made toward increasing medical student exposure to orthopaedics and to female mentors in an effort to ensure that the field continues to attract the nation's top medical graduates.

Analysis of Factors Related to the Sex Diversity of Orthopaedic Residency Programs in the United States

BACKGROUND

Women are underrepresented as applicants to and trainees of orthopaedic surgery residencies. Factors that attract women to or deter them from orthopaedic surgery have been previously published; however, there has been no analysis of the programs that train high percentages of female residents and the factors that differentiate them from programs that have low percentages of women. The purpose of this study was to identify and compare these factors between programs with high and low percentages of female residents.

METHODS

Information on each orthopaedic surgery residency program listed in the American Medical Association (AMA) Fellowship and Residency Electronic Interactive Database (FREIDA) was collected utilizing residency program web sites, an online survey distributed to residency program coordinators, and a follow-up telephone survey. These included data on resident and faculty demographic characteristics and residency program curriculum structure. The prevalence of factors in programs with the highest percentages of female residents was compared with those with lower percentages.

RESULTS

Data were obtained from 143 (97.3%) of 147 programs, with 3,406 residents identified. Only 485 residents (14.2%) were female. Programs with more female residents had more female faculty members per program (p = 0.001), a higher percentage of faculty who were female (p < 0.001), more female associate professors (p < 0.001), more women in leadership positions (p < 0.001), and a higher prevalence of women's sports medicine programs (p = 0.03); were more commonly listed in the Top 40 for National Institutes of Health (NIH) funding (p = 0.03) and U.S. News & World Report rankings (p = 0.02); and were more likely to offer a research year (p = 0.045).

CONCLUSIONS

There are greater percentages of female residents at orthopaedic residency programs with more female faculty members, more women in leadership positions, a women's sports medicine program, and the option to do a research year. Departmental and national leaders may consider these factors when efforts are undertaken to enhance the recruitment of female applicants and improve female interest in orthopaedic surgery as a specialty.

Current Publication Rates of Abstracts Presented at the Orthopaedic Trauma Association Annual Meetings: 2005-2010

OBJECTIVES

To evaluate the publication rate of abstracts presented at the 2005-2010 Orthopaedic Trauma Association (OTA) Annual Meetings.

METHODS

All abstracts from the 2005 to 2010 OTA meetings were identified through the OTA's official website. Each abstract was searched across PubMed and Google to determine its publication status. The overall publication rate of abstracts was determined, along with the first authors' sex, number of authors, time and journal of publication, and analyzed with statistical testing.

RESULTS

Of the 392 abstracts presented at the 2005-2010 OTA meetings, the overall publication rate was 66.3%, with an overall mean time to publication of 28.3 months. The Journal of Orthopaedic Trauma published 38.5% of published OTA abstracts, the most of any journal. The proportions of published OTA abstracts with female first authors exhibit increasing trends within the time period.

CONCLUSION

The quality of research presented at OTA meetings is relatively high compared with other orthopaedic meetings, with 66.3% of OTA abstracts progressing to peer-reviewed publication. The publication rate of 2005-2010 OTA abstracts was greater than that of the 1990-1995 abstracts. The Journal of Orthopaedic Trauma remains the most frequent publisher of manuscripts presented as abstracts at OTA meetings. Although most abstracts are eventually published, the information presented at these meetings, like all scholarly work, should be critically evaluated as they have undergone a less robust peer-review process and may be modified in the future in preparation for publication.

Assessment of Female Medical Students' Interest in Careers in Cardiothoracic Surgery

OBJECTIVE

Although over half of medical students are females, women comprise only 21% of cardiothoracic (CT) surgery residency applicants and 5% of the CT workforce. We sought to gain insight into female medical students' perceptions of CT surgery and identify targets to increase interest.

DESIGN

A 33-question survey queried career selection factors, perceptions of CT surgery, and ways to increase interest in the field. Responses were stratified by sex and preclinical versus clinical years.

SETTING

Women at 13 US medical schools were compared to men at a Midwest medical school.

PARTICIPANTS

Surveys were distributed to approximately 4400 women and were completed by 372 (8.5%) women. Comparison surveys were distributed to approximately 170 preclinical men and were completed by 98 (57.6%) men.

RESULTS

Preclinical woman had broad interests, whereas clinical women were more interested in primary care (p = 0.0124). Intellectual interest and lifestyle were important in specialty selection for men and women (91% versus 90%; 78% versus 86%). Although preclinical men valued perceived prestige and salary significantly more than preclinical women (39% versus 20%, p = 0.0014; 64% versus 48%, p = 0.0173), preclinical women valued caring for specific ethnicities and addressing health disparities significantly more than preclinical men (26% versus 15%, p = 0.0173; 53% versus 33%, p = 0.0019). Making family plans was cited by 83% of women as difficult if they choose to become a CT surgeon. Women thought that attaining their career interests and life goals (76%) or access to female CT surgery mentors (63%) would make the field more appealing. Over 70% of preclinical women were interested in shadowing a CT surgeon. Of these women, 12% attempted to shadow.

CONCLUSIONS

Although baseline interest in CT surgery is low among women, there are many targets for increasing interest especially during preclinical years. Residency programs have the opportunity to entice women to the field by addressing their priorities of lifestyle, family planning, and addressing health disparities.

[Bootcamp: longitudinal gender-based surgical and clinical skills training]

BACKGROUND

Sex parity of medical students has increased to the degree that approximately 50 % of medical students are women. Orthopedic and trauma surgery, however, has not managed to keep up with this trend and women are still grossly underrepresented.

OBJECTIVES

Description of an innovative longitudinal gender-based surgical and clinical skills training course.

METHODS

An elective 5-day modular skills course is offered for third to fifth year medical students. Module 1 aims at teaching basic surgical and communication skills involving local and regional anesthesia, initial experience with arthroscopy, fracture fixation, emergency measures as well as communication skills training using standardized patients. The subsequent modules cover surgical knowledge and skills of increasing complexity. The main goals are to increase the interest in orthopedic trauma surgery and to reduce concerns regarding discrimination and gender-related issues. Learning outcomes are assessed using a 6-item multiple choice questionnaire (MCQ) and a 3-stage objective structured clinical examination (OSCE) regarding induction of anesthesia, arthroscopy simulation and communication skills.

RESULTS

A total of 52 second year medical students (39 females, 13 males) completed module I. There were no differences between men and women with regard to the MCQ and anesthesia and communication skills; however, male students scored significantly higher in the arthroscopy test. All students rated the course as being highly effective in terms of acquisition of knowledge and skills. Almost all participants would recommend the course to fellow students and 70 % of participants stated they would participate in the advanced courses. Female participants in particular reported a marked increase in interest in orthopedic trauma surgery and less concerns regarding discrimination and gender-related issues.

CONCLUSION

The effectiveness of the approach will have to be proven by further evaluation, especially with respect to assessment of career development and application rates of participants. Adaptation of environmental and working conditions to suit women's needs seem to play an important role in promoting new surgery residents.

Medical School Experiences Shape Women Students' Interest in Orthopaedic Surgery

BACKGROUND

Orthopaedic surgery now has the lowest percentage of women in residency programs of any surgical specialty. Understanding factors, particularly those related to the medical school experience, that contribute to the specialty's inability to draw from the best women students is crucial to improving diversity in the profession.

QUESTIONS/PURPOSES

(1) Does required medical school exposure to orthopaedic surgery increase the proportion of women choosing the specialty? (2) Do negative perceptions deter women from choosing orthopaedic surgery? (3) What proportion of orthopaedic faculty members are women, and what proportion of residents are women? (4) To what degree has gender bias been identified in the application/interview process?

METHODS

Two PubMed searches of articles between 2005 and 2015 were performed using a combination of medical subject headings. The first search combined "Orthopaedics" with "Physicians, women" and phrases "women surgeons" or "female surgeons" and the second combined "Orthopedics" with "Internship & Residency" or "exp Education, Medical" and "Sex Ratio" or "Sex Factors", resulting in 46 publications of which all abstracts were reviewed resulting in 11 manuscripts that were related to the research questions. The Google Scholar search of "women in orthopaedic surgery" identified one additional publication. These 12 manuscripts were read and bibliographies of each reviewed with two additional publications identified and included.

RESULTS

Required exposure to orthopaedics was found to be positively associated with the number of women applicants to the field, whereas negative perceptions have been reported to deter women from choosing orthopaedic surgery. Orthopaedics has the lowest percentage of women faculty and women residents (14%) compared with other specialties; this suggests that same gender mentorship opportunities are limited. For women applying to orthopaedics, gender bias is most evident through illegal interview questions, in which women are asked such questions more often than men (such as family planning questions, asked to 61% of women versus 8% of men).

CONCLUSIONS

Successful recruitment of women to orthopaedic surgery may be improved by early exposure and access to role models, both of which will help women students' perceptions of their role in field of orthopaedic surgery.

The Perry Initiative's Medical Student Outreach Program Recruits Women Into Orthopaedic Residency

BACKGROUND

Orthopaedic surgery lags behind other surgical specialties in terms of gender diversity. The percentage of women entering orthopaedic residency persistently remains at 14% despite near equal ratios of women to men in medical school classes. This trend has been attributed to negative perceptions among women medical students of workplace culture and lifestyle in orthopaedics as well as lack of exposure, particularly during medical school when most women decide to enter the field. Since 2012, The Perry Initiative, a nonprofit organization that is focused on recruiting and retaining women in orthopaedics, had conducted extracurricular outreach programs for first- and second-year female medical students to provide exposure and mentoring opportunities specific to orthopaedics. This program, called the Medical Student Outreach Program (MSOP), is ongoing at medical centers nationwide and has reached over 300 medical students in its first 3 program years (2012-2014).

QUESTIONS/PURPOSES

(1) What percentage of MSOP participants eventually match into orthopaedic surgery residency? (2) Does MSOP impact participants' perceptions of the orthopaedics profession as well as intellectual interest in the field?

METHODS

The percentage of program alumnae who matched into orthopaedics was determined by annual followup for our first two cohorts who graduated from medical school. All program participants completed a survey immediately before and after the program that assessed the impact of MSOP on the student's intention to pursue orthopaedics as well as perceptions of the field and intellectual interest in the discipline.

RESULTS

The orthopaedic surgery match rate for program participants was 31% in our first graduating class (five of 16 participants in 2015) and 28% in our second class (20 of 72 participants in 2016). Pre/post program comparisons showed that the MSOP influenced students' perceptions of the orthopaedics profession as well as overall intellectual interest in the field.

CONCLUSIONS

The results of our study suggest that The Perry Initiative's MSOP positively influences women to choose orthopaedic surgery as a profession. The match rate for program alumnae is twice the percentage of females in current orthopaedic residency classes. Given these positive results, MSOP can serve as a model, both in its curricular content and logistic framework, for other diversity initiatives in the field.

Medical students' and interns' interest in orthopedic surgery: the gender factor

OBJECTIVE

There is an extremely small proportion of female medical students choosing to specialize in orthopedic surgery. The aim of the study was to assess medical students' and interns' interests and perceptions of orthopedic surgery and explore why women are not interested in orthopedic surgery.

SETTING

Questionnaires were distributed to final-year medical students and interns assessing their interests and perception of orthopedic surgery.

PARTICIPANTS

Final-year medical students and interns.

RESULTS

Responses were obtained from 317 students and 199 interns. Among the medical students, 15% were interested in orthopedic surgery, but only 2% were women. Both male and female students perceived orthopedics as an "action"-packed, procedure-based profession, providing instant gratification, time in the operating room, high income, and the option for private practice. Female medical students considered it boring. Among interns, 11% were interested in orthopedic surgery; however, only 2% were women. When compared with the interns who were not interested in orthopedic surgery, a greater number of the interns interested in orthopedic surgery rated time with family and a procedure-intensive profession as important. Female students and interns were also interested in other surgical fields.

CONCLUSIONS

The increasing majority of women among medical students will reshape the future of physician workforce by dictating changes in workforce participation, working conditions, and intercollegial relationships. Orthopedic surgery will need to adapt to these realities.