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Bellomo TR, Reikersdorfer K, Grobman B, Lella SK, Zacharias N, Abai B, Slaw K, Garcia-Toca M. A comprehensive analysis of leadership attributes, discrepancies, and implications for gender equity in vascular surgery. J Vasc Surg 2024:S0741-5214(24)01236-9. [PMID: 38838967 DOI: 10.1016/j.jvs.2024.05.057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Revised: 03/23/2024] [Accepted: 05/06/2024] [Indexed: 06/07/2024]
Abstract
OBJECTIVE Well-developed leadership skills have been associated with a better understanding of health care context, increased team performance, and improved patient outcomes. Surgeons, in particular, stand to benefit from leadership development. Although studies have focused on investigating knowledge gaps and needs of surgeons in leadership roles, there is a noticeable gap in the literature concerning leadership in vascular surgery. The goal of this study was to characterize current leadership attributes of vascular surgeons and understand demographic influences on leadership patterns. METHODS This retrospective cohort study was a descriptive analysis of vascular surgeons and their observers who took the Leadership Practices Inventory (LPI) from 2020 to 2023. The LPI is a 30-question inventory that measures the frequency of specific leadership behaviors across five practices of leadership. RESULTS A total of 110 vascular surgeons completed the LPI. The majority of participants were White (56%) and identified as male (60%). Vascular surgeons most frequently observed the "enabling others to act" leadership practice style (8.90 ± 0.74) by all evaluators. Vascular surgeons were most frequently above the 70th percentile in the "challenge the process" leadership practice style (49%) compared with the average of other leaders worldwide. Observers rated vascular surgeons as displaying significantly more frequent leadership behaviors than vascular surgeons rated themselves in every leadership practice style (P < .01). The only demographic variable associated with a significantly increased occurrence of achieving 70th percentile across all five leadership practice styles was the male gender: a multivariable model adjusting for objective experience showed that men were at least 3.5 times more likely to be rated above the 70th percentile than women. CONCLUSIONS Vascular surgeons under-report the frequency at which they practice leadership skills across all five leadership practice styles and should recognize their strengths of enabling others to act and challenging the process. Men are recognized as exhibiting all five leadership practices more frequently than women, regardless of current position or experience level. This observation may reflect the limited leadership positions available for women, thereby restricting their opportunities to demonstrate leadership practices as frequently or recognizably as their male counterparts.
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Affiliation(s)
- Tiffany R Bellomo
- Division of Vascular and Endovascular Surgery, Massachusetts General Hospital, Boston, MA; Harvard Medical School, Massachusetts General Hospital, Boston, MA.
| | | | - Benjamin Grobman
- Harvard Medical School, Massachusetts General Hospital, Boston, MA
| | - Srihari K Lella
- Division of Vascular and Endovascular Surgery, Massachusetts General Hospital, Boston, MA; Harvard Medical School, Massachusetts General Hospital, Boston, MA
| | - Nikolaos Zacharias
- Division of Vascular and Endovascular Surgery, Massachusetts General Hospital, Boston, MA; Harvard Medical School, Massachusetts General Hospital, Boston, MA
| | - Babak Abai
- Vascular and Endovascular Surgery, Thomas Jefferson University, Philadelphia, PA
| | - Ken Slaw
- Society for Vascular Surgery, Rosemont, IL
| | - Manuel Garcia-Toca
- Division of Vascular Surgery and Endovascular Therapy, Emory University School of Medicine, Atlanta, GA
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Jelmoni AJM, Mascaro L, Mariola C, Conde MM, Uralov D, Caniglia F, Chebaro K, Rosellini E, Zaed I, Milani D, Cannizzaro D. Trends in Female Authorship Over 5-Year Publication History in Neurovascular Surgery. World Neurosurg 2024; 184:219-226. [PMID: 38266985 DOI: 10.1016/j.wneu.2024.01.095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 10/24/2023] [Accepted: 01/16/2024] [Indexed: 01/26/2024]
Affiliation(s)
- Alice J M Jelmoni
- Department of Biomedical Sciences, Humanitas University, Rozzano, Italy
| | - Luca Mascaro
- Department of Biomedical Sciences, Humanitas University, Rozzano, Italy
| | - Carlotta Mariola
- Department of Biomedical Sciences, Humanitas University, Rozzano, Italy
| | - Marian Mora Conde
- Department of Biomedical Sciences, Humanitas University, Rozzano, Italy.
| | - Daniel Uralov
- Department of Biomedical Sciences, Humanitas University, Rozzano, Italy
| | | | - Kamel Chebaro
- Department of Biomedical Sciences, Humanitas University, Rozzano, Italy
| | - Elena Rosellini
- Department of Biomedical Sciences, Humanitas University, Rozzano, Italy
| | - Ismail Zaed
- Department of Neurosurgery, Neurocenter of South Switzerland, Ente Ospedaliero Cantonale, Lugano, Switzerland
| | - Davide Milani
- Department of Neurosurgery, Neurocenter of South Switzerland, Ente Ospedaliero Cantonale, Lugano, Switzerland
| | - Delia Cannizzaro
- Department of Neurosurgery, ASST Ovest Milano Legnano Hospital, Legnano (Milan), Italy
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Fox N, Schroll R, Quiodettis M, Ito K, Bulger EM. Women in trauma surgery: advancing our profession through international collaboration. Trauma Surg Acute Care Open 2024; 9:e001366. [PMID: 38476761 PMCID: PMC10928748 DOI: 10.1136/tsaco-2024-001366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/14/2024] Open
Affiliation(s)
- Nicole Fox
- Cooper University Health Care, Camden, New Jersey, USA
| | | | | | - Kaori Ito
- Emergency Medicine, Teikyo Daigaku Igakubu Fuzoku Byoin, Itabashi-ku, Japan
| | - Eileen M Bulger
- Department of Surgery, University of Washington, Seattle, Washington, USA
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Rama E, Ekhtiari S, Thevendran G, Green J, Weber K, Khanduja V. Overcoming the Barriers to Diversity in Orthopaedic Surgery: A Global Perspective. J Bone Joint Surg Am 2023; 105:1910-1919. [PMID: 37639495 DOI: 10.2106/jbjs.23.00238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/31/2023]
Abstract
BACKGROUND Diversity in orthopaedics continues to lag behind that in other surgical specialties. This pattern exists globally and is not unique to gender or race. This review offers a global perspective on overcoming the barriers to diversity in orthopaedics. METHODS A literature search of MEDLINE and Embase was conducted and a narrative review was undertaken. Publications that discussed any aspect of diversity or solutions to diversity within orthopaedics or academic orthopaedics were identified. RESULTS A total of 62 studies were included. Studies showed that diversity in orthopaedic training is limited by structural barriers such as long hours, requirements to relocate during training, training inflexibility, and a lack of exposure to orthopaedics. Implicit bias during the selection process for training, discrimination, and a lack of role models are additional barriers that are experienced by both minority and female surgeons. The global lack of diversity suggests that there are also inherent "cultural barriers" that are unique to orthopaedics; however, these barriers are not uniformly experienced. Perceptions of orthopaedics as promoting an unhealthy work-life balance and the existence of a "boys' club" must be addressed. Strong, committed leaders can embed cultural norms, support trainees, and act as visible role models. Targeted efforts to increase diverse recruitment and to reduce bias in selection processes for medical school and specialty training will increase diversity in the "training pipeline." CONCLUSIONS Diversity in orthopaedics continues to lag behind that in other specialties. Increasing diversity is important for providing a more inclusive training environment, improving patient care, and reducing health disparities. Structural and cultural barriers need to be addressed to improve diversity in orthopaedics. Promoting a culture supportive of all surgeons is essential to reframing perceptions that may prevent individuals from even considering a career as an orthopaedic surgeon. Changing attitudes require focused efforts from committed leadership in a "top-down" approach that prioritizes diversity. The efforts from national bodies seeking to tackle the lack of diversity, as well as the establishment of organizations committed to diversity, such as the International Orthopaedic Diversity Alliance, provide reasons to be optimistic for the future.
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Affiliation(s)
- Essam Rama
- University of Cambridge, Cambridge, United Kingdom
| | - Seper Ekhtiari
- Addenbrooke's-Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | | | | | - Kristy Weber
- Penn Orthopaedics Perelman, Penn Medicine, Philadelphia, Pennsylvania
| | - Vikas Khanduja
- University of Cambridge, Cambridge, United Kingdom
- Addenbrooke's-Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
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Xu AL, Humbyrd CJ, De Mattos CBR, LaPorte D. The Importance of Perceived Barriers to Women Entering and Advancing in Orthopaedic Surgery in the US and Beyond. World J Surg 2023; 47:3051-3059. [PMID: 37735223 DOI: 10.1007/s00268-023-07165-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/18/2023] [Indexed: 09/23/2023]
Abstract
BACKGROUND Global perceptions of barriers to women in orthopaedics have not been assessed. The purpose of this study was to determine the importance of international barriers to women entering and advancing within orthopaedic surgery. METHODS An anonymous, online survey was distributed to women medical students, trainees, and practicing surgeons via Women in Orthopaedics Worldwide, the "Women in Ortho" Facebook page, and individual programmes. Participants were asked to rate perceived barriers to (1) pursuing training and (2) career advancement on a scale of 1-5, with 5 being the most important and relative to other barriers. Descriptive statistics and univariate analyses were employed. RESULTS The survey yielded 237 US (84.0%) and 45 international (16.0%) respondents. Per entering orthopaedic surgery, the most important barriers were male-dominated culture, lack of a strong women mentor, and lack of female representation at home institution. Compared with the US surgeons/trainees, international respondents cited greater societal disapproval (2.8 ± 1.2 vs. 3.4 ± 1.3, P = 0.01). Medical students assigned less importance to lack of exposure, more to lack of resources for creating competitive applications (P < 0.05). Regarding career advancement, lack of women leadership, family responsibilities, and gender-biased selection for promotion were the most important. International surgeons/trainees noted greater concern for societal disapproval (3.5 ± 1.5 vs. 2.6 ± 1.3, P = 0.003) and were more likely to rank sexual harassment in their top three (17.6 vs. 4.2%, P = 0.02). CONCLUSION While notable differences exist, there is striking similarity across countries and position levels in perceived barriers to women entering and advancing in orthopaedic surgery. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Amy L Xu
- Department of Orthopaedic Surgery, The Johns Hopkins Hospital, 1800 Orleans Street, Baltimore, MD, 21287, USA.
| | - Casey J Humbyrd
- Department of Orthopaedic Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | | | - Dawn LaPorte
- Department of Orthopaedic Surgery, The Johns Hopkins Hospital, 1800 Orleans Street, Baltimore, MD, 21287, USA
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Ngaage LM, Borrelli MR, Ketheeswaran S, Shores JT. Article Factors Influencing Gender Disparities in Senior Authorship of Plastic Surgery Publications. Ann Plast Surg 2023; 91:638-643. [PMID: 37962253 DOI: 10.1097/sap.0000000000003709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2023]
Abstract
INTRODUCTION Female plastic surgeons publish fewer and lower impact articles. To better understand how to address this gender gap, we explored the temporal trends in female senior authorship and evaluated predictive factors for female senior authorship. METHODS A retrospective review of articles published in the 3 highest impact plastic surgery journals published from 2010 to 2020 was conducted. Trends with female senior authorship across time were analyzed with respect to study type, subspeciality, and geographical origin. RESULTS Of the 5425 articles included, 13% (n = 720) had a female senior author, and female senior authorship increased across time ( R = 0.84, P = 0.033). Over the decade, an increased proportion of cohort studies ( R = 0.82, P = 0.045), systematic reviews ( R = 0.96, P = 0.003), breast-related articles ( R = 0.88, P = 0.022), and reconstruction-related articles ( R = 0.83, P = 0.039) were published by female senior authors. Subspecialty and geography predicted female senior authorship; articles focused on aesthetic (odds ratio [OR] = 1.3, P = 0.046) and breast (OR = 1.7, P < 0.001) subspecialties or those originating from Canada (OR = 1.7 P = 0.019), Europe (OR = 1.5, P < 0.001), and Latin America (OR = 3.0, P < 0.001) were more likely to have a female senior author. Articles from East Asia were less likely to have female senior authors (OR = 0.7, P = 0.005). CONCLUSION Female senior authorship in plastic surgery has increased over the last decade, and the proportion of female plastic surgeons leading cohort studies and systematic reviews is increasing. Sex of the senior author is influenced by plastic surgery subspecialty and geographical origin, but article type did not impact the odds of female senior authorship.
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Affiliation(s)
- Ledibabari Mildred Ngaage
- From the Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Mimi R Borrelli
- Department of Plastic and Reconstructive Surgery, Brown University School of Medicine, Providence, RI
| | - Suvethavarshini Ketheeswaran
- From the Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Jaimie T Shores
- From the Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
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Mishra K, Kovoor JG, Gupta AK, Bacchi S, Lai CS, Stain SC, Maddern GJ. Evolving challenges of leadership in surgery to improve inclusivity, representation, and well-being. Br J Surg 2023; 110:1723-1729. [PMID: 37758505 DOI: 10.1093/bjs/znad274] [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: 04/11/2023] [Revised: 06/18/2023] [Accepted: 08/08/2023] [Indexed: 10/03/2023]
Abstract
BACKGROUND Leadership is a complex and demanding process crucial to maintaining quality in surgical systems of care. Once an autocratic practice, modern-day surgical leaders must demonstrate inclusivity, flexibility, emotional competence, team-building, and a multidisciplinary approach. The complex healthcare environment challenges those in leadership positions. The aim of this narrative review was to consolidate the major challenges facing surgeons today and to suggest evidence-based strategies to support surgical leaders. METHODS Google Scholar, PubMed, MEDLINE, and Ovid databases were searched to review literature on the challenges faced by surgical leaders. The commonly identified areas that compromise inclusivity and productive leadership practices were consolidated into 10 main subheadings. Further research was conducted using the aforementioned databases to outline the importance of addressing such challenges, and to consolidate evidence-based strategies to resolve them. RESULTS The importance of increasing representation of marginalized groups in leadership positions, including women, ethnic groups, the queer community, and ageing professionals, has been identified by surgical colleges in many countries. Leaders must create a collegial environment with proactive, honest communication and robust reporting pathways for victims of workplace harassment. The retention of diverse, empowering, and educating leaders relies on equitable opportunities, salaries, recognition, and support. Thus, it is important to implement formal training and mentorship, burnout prevention, conflict management, and well-being advocacy. CONCLUSION There are two aspects to addressing challenges facing surgical leadership; improving advocacy by and for leaders. Systems must be designed to support surgical leaders through formal education and training, meaningful mentorship programmes, and well-being advocacy, thus enabling them to proactively and productively advocate and care for their patients, colleagues, and professional communities.
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Affiliation(s)
- Kritika Mishra
- Flinders University, Adelaide, South Australia, Australia
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Joshua G Kovoor
- Discipline of Surgery, University of Adelaide, Queen Elizabeth Hospital, Adelaide, South Australia, Australia
- Royal Australasian College of Surgeons, Adelaide, South Australia, Australia
| | - Aashray K Gupta
- Discipline of Surgery, University of Adelaide, Queen Elizabeth Hospital, Adelaide, South Australia, Australia
- Gold Coast University Hospital, Gold Coast, Queensland, Australia
| | - Stephen Bacchi
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
- University of Adelaide, Adelaide, South Australia, Australia
- Flinders Medical Centre, Adelaide, South Australia, Australia
| | - Christine S Lai
- Discipline of Surgery, University of Adelaide, Queen Elizabeth Hospital, Adelaide, South Australia, Australia
- Royal Australasian College of Surgeons, Adelaide, South Australia, Australia
| | - Steven C Stain
- Department of Surgery, Lahey Hospital and Medical Center, Burlington, Massachusetts, USA
| | - Guy J Maddern
- Discipline of Surgery, University of Adelaide, Queen Elizabeth Hospital, Adelaide, South Australia, Australia
- Royal Australasian College of Surgeons, Adelaide, South Australia, Australia
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He ZW, Wang C, Li Y, Danzeng A, Liu FB, Zhu Y, Shi JY, Ciren P, Yuan XY, Wu CX, Lan RH, Zhang BH. The state of female hepato-pancreato-biliary (HPB) surgeons in China: see us in operation theater with great prospects. HPB (Oxford) 2023; 25:1402-1410. [PMID: 37543474 DOI: 10.1016/j.hpb.2023.07.884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 06/02/2023] [Accepted: 07/12/2023] [Indexed: 08/07/2023]
Abstract
OBJECTIVE This study aims to investigate the proportion and distribution of female HPB surgeons in China, describe their current status, and analyze the possible barriers and challenges in their careers. METHOD Tertiary hospitals with the division of HPB in mainland China in 2021 were enrolled and surgeon demographic information was collected through the review of official websites and/or telephone interviews. RESULTS The majority of female HPB surgeons (72.92%) were located in the first or second-tier cities in mainland China, with an increasing number of new female HPB surgeons entering the field annually, particularly after 2005 (from 27 to 52 per 5 years). Despite no significant difference in academic backgrounds, female HPB surgeons initiated their careers at an earlier age and took a longer time to obtain chief titles (P < 0.05). Interestingly, female HPB surgeons performed laparoscopic complex HPB cases at a similar rate (95.42%) to their male counterparts and were more likely to specialize in endoscopic surgery (P = 0.021), with a similar ratio of obtaining administrative positions. CONCLUSION Minimally invasive surgery may provide females with unprecedented opportunities in the HPB surgery field. However, despite the increasing numbers of female HPB surgeons, the proportion remains low in China.
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Affiliation(s)
- Zheng-Wei He
- Hepatic Surgery Center, Institute of Hepato-pancreato-biliary Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China; Division of Hepato-pancreato-biliary Surgery, Tianyou Hospital, Wuhan University of Science and Technology, Wuhan, 430064, China
| | - Chao Wang
- Hepatic Surgery Center, Institute of Hepato-pancreato-biliary Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Yong Li
- Division of Hepato-pancreato-biliary Surgery, Tianyou Hospital, Wuhan University of Science and Technology, Wuhan, 430064, China
| | - Awang Danzeng
- Hepatic Surgery Center, Institute of Hepato-pancreato-biliary Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Fu-Bin Liu
- Division of Hepato-pancreato-biliary Surgery, Tianyou Hospital, Wuhan University of Science and Technology, Wuhan, 430064, China
| | - Yuan Zhu
- School of Automation, China University of Geosciences, Wuhan, 430074, China
| | - Jia-Yu Shi
- Division of Hepato-pancreato-biliary Surgery, Tianyou Hospital, Wuhan University of Science and Technology, Wuhan, 430064, China
| | - Pingcuo Ciren
- Hepatic Surgery Center, Institute of Hepato-pancreato-biliary Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Xiao-Yin Yuan
- Division of Hepato-pancreato-biliary Surgery, Tianyou Hospital, Wuhan University of Science and Technology, Wuhan, 430064, China
| | - Cheng-Xian Wu
- Division of Hepato-pancreato-biliary Surgery, Tianyou Hospital, Wuhan University of Science and Technology, Wuhan, 430064, China
| | - Run-Hu Lan
- Division of Hepato-pancreato-biliary Surgery, Tianyou Hospital, Wuhan University of Science and Technology, Wuhan, 430064, China
| | - Bin-Hao Zhang
- Hepatic Surgery Center, Institute of Hepato-pancreato-biliary Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China; Division of Hepato-pancreato-biliary Surgery, Tianyou Hospital, Wuhan University of Science and Technology, Wuhan, 430064, China.
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Sugo N, Terazono S, Matsuura C, Fuchinoue Y, Sakaeyama Y, Abe M, Mikai M, Kubota S, Kondo K, Shimokawa S, Maehara T, Akutsu H, Ikawa F, Enomoto Y, Kamiya K, Kuroda S, Takeshima H, Tamura N, Hishikawa T, Fujii M, Fujimaki T, Horiuchi T, Yamamoto J, Yamamoto T, Kato Y. Academic Activities of Female Neurosurgeons in All Branch Meetings of the Japan Neurosurgical Society. Neurol Med Chir (Tokyo) 2023; 63:457-463. [PMID: 37495519 PMCID: PMC10687666 DOI: 10.2176/jns-nmc.2023-0051] [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: 03/10/2023] [Accepted: 05/29/2023] [Indexed: 07/28/2023] Open
Abstract
This study aims to evaluate the academic activities of female neurosurgeons at all branch meetings of the Japan Neurosurgical Society and identify related issues they encountered. The programs of all seven branch meetings of the Japan Neurosurgical Society (Hokkaido, Tohoku, Kanto, Chubu, Kinki, Chugoku/Shikoku, and Kyushu) were used to determine the number of presentations and chairpersons by sex. The covered period was from January 2008 to December 2020, which was available for viewing during the survey. Of note, only the Kinki branch used data from January 2008 to December 2019. The Neurologia Medico-chirurgica (NMC), the journal of the Japan Neurosurgical Society, was also reviewed to identify publication achievements during the same period. In all seven branches, the percentage of presentations given by female physicians increased from 7.9% in 2008 to 9.6% in 2020 (p < 0.05).Conversely, the percentage of female chairpersons in all branch meetings did not change over time and it was significantly lower (1.1%) than that of female presenters (7.9%) for all branch meetings combined in over 13 years (p < 0.01). In the NMC, the number of articles with female physicians as first authors did not increase or decrease over the years. We conclude that efforts to smoothly promote female neurosurgeons as chairpersons and increase the number of female first authors are necessary to facilitate their academic activities.
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Affiliation(s)
- Nobuo Sugo
- Department of Neurosurgery (Omori), School of Medicine, Faculty of Medicine, Toho University
- Committee for the Promotion of Diversity, Japan Neurosurgical Society
| | - Sayaka Terazono
- Department of Neurosurgery (Omori), School of Medicine, Faculty of Medicine, Toho University
| | - Chie Matsuura
- Department of Neurosurgery (Omori), School of Medicine, Faculty of Medicine, Toho University
| | - Yutaka Fuchinoue
- Department of Neurosurgery (Omori), School of Medicine, Faculty of Medicine, Toho University
| | - Yuki Sakaeyama
- Department of Neurosurgery (Omori), School of Medicine, Faculty of Medicine, Toho University
| | - Mitsuyoshi Abe
- Department of Neurosurgery (Omori), School of Medicine, Faculty of Medicine, Toho University
| | - Masataka Mikai
- Department of Neurosurgery (Omori), School of Medicine, Faculty of Medicine, Toho University
| | - Syuhei Kubota
- Department of Neurosurgery (Omori), School of Medicine, Faculty of Medicine, Toho University
| | - Kosuke Kondo
- Department of Neurosurgery (Omori), School of Medicine, Faculty of Medicine, Toho University
| | - Shoko Shimokawa
- Committee for the Promotion of Diversity, Japan Neurosurgical Society
- Department of Neurosurgery, Kurume University School of Medicine
| | - Taketoshi Maehara
- Committee for the Promotion of Diversity, Japan Neurosurgical Society
- Department of Neurosurgery, Tokyo Medical and Dental University
| | - Hiroyoshi Akutsu
- Committee for the Promotion of Diversity, Japan Neurosurgical Society
- Department of Neurosurgery, Dokkyo Medical University
| | - Fusao Ikawa
- Committee for the Promotion of Diversity, Japan Neurosurgical Society
- Department of Neurosurgery, Shimane Prefectural Central Hospital
| | - Yukiko Enomoto
- Committee for the Promotion of Diversity, Japan Neurosurgical Society
- Department of Neurosurgery, Gifu University Graduate School of Medicine
| | - Kazuko Kamiya
- Committee for the Promotion of Diversity, Japan Neurosurgical Society
- Department of Neurosurgery, Norikura-Tatamidaira Clinic
| | - Satoshi Kuroda
- Committee for the Promotion of Diversity, Japan Neurosurgical Society
- Department of Neurosurgery, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama
| | - Hideo Takeshima
- Committee for the Promotion of Diversity, Japan Neurosurgical Society
- Department of Neurosurgery, Faculty of Medicine, University of Miyazaki
| | - Noriko Tamura
- Committee for the Promotion of Diversity, Japan Neurosurgical Society
- Department of Neurosurgery, Gotenyama Orthopedic Rehab Clinic
| | - Tomohito Hishikawa
- Committee for the Promotion of Diversity, Japan Neurosurgical Society
- Department of Neurological Surgery, Okayama University Faculty of Medicine, Dentistry and Pharmaceutical Sciences
| | - Masazumi Fujii
- Committee for the Promotion of Diversity, Japan Neurosurgical Society
- Department of Neurosurgery, Fukushima Medical University School of Medicine
| | - Takamitsu Fujimaki
- Committee for the Promotion of Diversity, Japan Neurosurgical Society
- Department of Neurosurgery, Saitama Medical University
| | - Tetsuyoshi Horiuchi
- Committee for the Promotion of Diversity, Japan Neurosurgical Society
- Department of Neurosurgery, Shinshu University School of Medicine
| | - Junkoh Yamamoto
- Committee for the Promotion of Diversity, Japan Neurosurgical Society
- Department of Neurosurgery, University of Occupational and Environmental Health
| | - Tetsuya Yamamoto
- Committee for the Promotion of Diversity, Japan Neurosurgical Society
- Department of Neurosurgery, Yokohama City University Graduate School of Medicine
| | - Yoko Kato
- Committee for the Promotion of Diversity, Japan Neurosurgical Society
- Department of Neurosurgery, Fujita Health University, Bantane Hospital
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Kato N, Kojima T, Ouchi M, Nakamura T, Tokuda Y, Yakushiji T, Ichikawa K. Gender-based differences in the job titles and lifestyles in the cataract and refractive surgery society in Japan. Medicine (Baltimore) 2023; 102:e35216. [PMID: 37800820 PMCID: PMC10553083 DOI: 10.1097/md.0000000000035216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 08/23/2023] [Indexed: 10/07/2023] Open
Abstract
To investigate sex differences in the titles and lifestyles of Japanese ophthalmologists, we evaluated work places and private lives. Retrospective cross-sectional study. The study included 1721 members (1344 males and 377 females) of the Japanese Society of Cataract and Refractive Surgery. An online, anonymized questionnaire was distributed to the society members. The questionnaire included 40 questions to collect data on profiles, lifestyles, job title, families, spouses, children, household chores, child-rearing, and work satisfaction. In total, 219 members (144 males and 75 females; 53.4 ± 1.0 and 51.3 ± 9.9 years old, respectively) completed the questionnaire. The job title, working time, annual income, marriage rate, and the number of children significantly differed between male and female respondents. Female respondents had greater responsibilities toward house chores, child care, and nursing, whereas several male doctors had spouses who did not work or worked for shorter times, earned a lower income, and contributed greater toward family responsibilities. Female respondents changed their job titles after having children more frequently than male respondents. Both males and females had limited time available for community activities and volunteer work. There were no significant differences in daily sleep duration. Both sexes were equally satisfied with their career choice of ophthalmology; however, fewer females recommended ophthalmology as a career for students and children compared to males. There are significant sex differences among ophthalmologists in Japan in terms of family responsibilities; this topic has received insufficient attention.
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Affiliation(s)
| | | | | | | | | | - Tadayuki Yakushiji
- Department of Cardiology, Showa University Northern Yokohama Hospital, Kanagawa, Japan
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Brock J, Zehetmayer S, Gompelmann D. Women in Interventional Pulmonology: Results from a Worldwide Survey. Respiration 2023; 102:613-620. [PMID: 37517403 DOI: 10.1159/000531581] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 06/07/2023] [Indexed: 08/01/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Gender inequality in medicine remains an issue. Despite the increasing proportion of female physicians, women still appear underrepresented in interventional pulmonology (IP) careers. To date, no data are available on the gender distribution in IP. METHOD An online survey was sent to pulmonary physicians internationally between July and December 2022. The survey included questions on gender diversity in the pulmonology departments, such as the proportion of male, female, and gender diverse physicians performing bronchoscopy, career progression, and social life. RESULTS Responses from 92 physicians (mean age 45 ± 10 years) from 47 hospitals across 17 countries were analysed, of whom 52% were women. Overall, 79% of the respondents were pulmonologists and 83% perform bronchoscopy. Although men continue to dominate bronchoscopy (65 vs. 43%) and are more likely to be involved in research (89 vs. 77%), the observed difference is statistically not significant (p = 0.135 and p = 0.281). Leading positions are held by 60% of male respondents and 23% of female respondents (p = 0.002). Men are also more often reported to have academic awards. Discrimination based on gender was reported by 5.3% of all men and 26.8% of all women (p = 0.023). CONCLUSIONS Men and women are almost equally involved in IP, especially in female-led bronchoscopy units. However, leading positions and academic awards are still predominantly held by men.
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Affiliation(s)
- Judith Brock
- Department of Pneumology and Critical Care Medicine, Thoraxklinik, University of Heidelberg, Heidelberg, Germany
- Translational Lung Research Center Heidelberg (TLRC) of the German Center for Lung Research (DZL), Heidelberg, Germany
| | - Sonja Zehetmayer
- Center for Medical Data Science, Medical University of Vienna, Vienna, Austria
| | - Daniela Gompelmann
- Division of Pulmonology, Department of Medicine II, Medical University of Vienna, Vienna, Austria
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Gauly J, Court R, Currie G, Seers K, Clarke A, Metcalfe A, Wilson A, Hazell M, Grove AL. Advancing leadership in surgery: a realist review of interventions and strategies to promote evidence-based leadership in healthcare. Implement Sci 2023; 18:15. [PMID: 37179327 PMCID: PMC10182608 DOI: 10.1186/s13012-023-01274-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 05/05/2023] [Indexed: 05/15/2023] Open
Abstract
BACKGROUND Healthcare systems invest in leadership development of surgeons, surgical trainees, and teams. However, there is no agreement on how interventions should be designed, or what components they must contain to be successful. The objective of this realist review was to generate a programme theory explaining in which context and for whom surgical leadership interventions work and why. METHODS Five databases were systematically searched, and articles screened against inclusion considering their relevance. Context-mechanism-outcome configurations (CMOCs) and fragments of CMOCs were identified. Gaps in the CMOCs were filled through deliberation with the research team and stakeholder feedback. We identified patterns between CMOCs and causal relationships to create a programme theory. RESULTS Thirty-three studies were included and 19 CMOCs were developed. Findings suggests that interventions for surgeons and surgical teams improve leadership if timely feedback is delivered on multiple occasions and by trusted and respected people. Negative feedback is best provided privately. Feedback from senior-to-junior or peer-to-peer should be delivered directly, whereas feedback from junior-to-senior is preferred when delivered anonymously. Leadership interventions were shown to be most effective for those with awareness of the importance of leadership, those with confidence in their technical surgical skills, and those with identified leadership deficits. For interventions to improve leadership in surgery, they need to be delivered in an intimate learning environment, consider implementing a speak-up culture, provide a variety of interactive learning activities, show a genuine investment in the intervention, and be customised to the needs of surgeons. Leadership of surgical teams can be best developed by enabling surgical teams to train together. CONCLUSIONS The programme theory provides evidence-based guidance for those who are designing, developing and implementing leadership interventions in surgery. Adopting the recommendations will help to ensure interventions are acceptable to the surgical community and successful in improving surgical leadership. TRIAL REGISTRATION The review protocol is registered with PROSPERO (CRD42021230709).
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Affiliation(s)
- Julia Gauly
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, CV4 7HL, UK
| | - Rachel Court
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, CV4 7HL, UK
| | - Graeme Currie
- Warwick Business School, University of Warwick, Scarman Rd, Coventry, CV4 7AL, UK
| | - Kate Seers
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, CV4 7HL, UK
| | - Aileen Clarke
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, CV4 7HL, UK
| | - Andy Metcalfe
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Gibbet Hill Campus, Coventry, CV4 7AL, UK
| | - Anna Wilson
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, CV4 7HL, UK
| | - Matthew Hazell
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, CV4 7HL, UK
| | - Amy Louise Grove
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, CV4 7HL, UK.
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Abstract
OBJECTIVE The objective of this study is to systematically synthesize the existing literature on the experiences of motherhood in female surgeons both during surgical training and as staff physicians, to identify knowledge gaps, and to provide recommendations for institutional changes to better support pregnant female surgeons. BACKGROUND There are disproportionately fewer medical students pursuing surgical specialties, as surgery is often seen as incompatible with childbearing and pregnancy. However, no review has summarized the published literature on the collective experiences of female surgeons in navigating motherhood. METHODS Four databases were searched and 1106 abstracts were identified. Forty-two studies were included and a thematic analysis was performed. RESULTS Four themes were identified: path toward motherhood (n=18), realities of motherhood (n=25), medical culture and its impact on career and family life (n=24), and institutional reproductive wellness policies (n=21). Female surgeons are more likely to delay motherhood until after training and have high rates of assisted reproductive technology use. Pregnancy during surgical training is associated with negative perception from peers, pregnancy complications, and scheduling challenges. Maternity leave policies and breastfeeding and childcare facilities are variable and often inadequate. Many female surgeons would agree that greater institutional support would help support women in both their roles as mothers and as surgeons. CONCLUSIONS Both female residents and staff surgeons experience significant and unique barriers before, during, and after motherhood that impact their personal and professional lives. Understanding the unique challenges that mothers face when pursuing surgical specialties is critical to achieving gender equity.
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14
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de Boer I, Ambrosini A, Halker Singh RB, Baykan B, Buse DC, Tassoreli C, Jensen RH, Pozo-Rosich P, Terwindt GM. Perceived barriers to career progression in the headache field: A global web-based cross-sectional survey. Cephalalgia 2022; 42:1498-1509. [PMID: 36071614 DOI: 10.1177/03331024221123081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND It is well recognized that underrepresented and minoritized groups do not have the same career opportunities. However, there are limited data on the range and specifics of potential barriers that withhold people in headache medicine and science from reaching their full potential. Moreover, people from different geographical regions often perceive different challenges. We aimed to identify world-wide perceived career barriers and possibilities for promoting equality amongst professionals in the headache fields. METHODS A cross-sectional online survey was conducted among professionals in the field of headache globally. The questions of the survey were aimed at assessing perceived career barriers in four domains: professional recognition, opportunities in scientific societies, clinical practice, and salary and compensation. Perceived mentorship was also assessed. RESULTS In total 580 responders completed the survey (55.3% women). Gender was the most important perceived barrier in almost all domains. Additionally, country of birth emerged as an important barrier to participation in international scientific societies. Career barriers varied across world regions. CONCLUSION It is essential that longstanding and ongoing disparities by gender and country of origin for professionals in the headache field are globally acknowledged and addressed in areas of recruitment, retention, opportunities, mentor- and sponsorships, and advancement.
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Affiliation(s)
- Irene de Boer
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands
| | | | | | - Betül Baykan
- Department of Neurology, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Dawn C Buse
- Department of Neurology, Albert Einstein College of Medicine, Bronx NY, USA
| | - Cristina Tassoreli
- Headache Science & Neurorehabilitation Center, IRCCS Mondino Foundation, Pavia, Italy.,Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Rigmor H Jensen
- Department of Neurology, Danish Headache Centre, University of Copenhagen, Rigshospitalet Glostrup, Glostrup, Denmark
| | - Patricia Pozo-Rosich
- Headache Unit, Neurology Department, Vall d'Hebron University Hospital, Barcelona, Spain.,Headache and Neurological Pain Research Group, Vall d'Hebron Research Institute, Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Gisela M Terwindt
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands
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15
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Zhou L, Liu B, Fu W, Wu W, Wang Y, Ju P, Zhang X, Liu G. Surgical career choices of medical students in China: does gender bias play a role? BMC MEDICAL EDUCATION 2022; 22:378. [PMID: 35581632 PMCID: PMC9112434 DOI: 10.1186/s12909-022-03453-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 05/09/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Gender bias in career choices has always been a matter of great concern, including in the field of medicine. This study reports on the current situation in this regard in China, including the reasons for Chinese medical students' willingness to engage in surgical careers; investigates their accounts of gender bias; and analyzes the effect of gender bias on their surgical career choices. METHODS This study invited medical students from Harbin Medical University to fill out a non-mandatory questionnaire on whether they had witnessed gender bias, their surgical career intentions, and factors influencing their career intentions. A one-way analysis of variance was used to compare the differences between continuous variables. Pearson's chi-squared test was used to compare the differences between the categorical variables, the Kendall correlation coefficient (tau) was used to assess the correlation between the reasons rankings reported by gender, and a multiple regression analysis was conducted by logit model. RESULTS A total of 643 students responded to the questionnaire. Of them, 63.76% expressed a willingness for a surgical career, with "interest" being a key driving factor (73.41%). Almost all respondents (96.27%) answered that there were more male leaders in the surgical departments they had rotated through or had contacted. Only a few respondents reported gender barriers influencing recruitment (32.19%). However, witnessing gender bias (recruitment of male required) was correlated to choice of surgical career (P < 0.05). Females were less willing to pursue a career in surgery if they had witnessed gender barriers in surgical recruitment. Male dominance also correlated to the choice of a surgical career (P < 0.1). Of the respondents, 53.19% believed that surgery was not suitable for females; among female respondents, this number was 56.12%, higher than for male respondents. When females think that the surgical profession is not suitable for them, it reduces the possibility of their pursuing a career in surgery. CONCLUSION Most medical students were interested in surgical care. Witnessing gender bias decreases females' willingness to pursue a career in surgery. It is necessary to stimulate medical students' interest in surgery when formulating strategies to promote surgical career choices, as well as to reduce gender bias in surgery; in this way, females' surgical careers should be ensured.
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Affiliation(s)
- Liangru Zhou
- School of Health Management, Harbin Medical University, 157 Baojian Road, Nangang District, Harbin, China
| | - Bingjie Liu
- School of Health Management, Harbin Medical University, 157 Baojian Road, Nangang District, Harbin, China
| | - Wenqi Fu
- School of Health Management, Harbin Medical University, 157 Baojian Road, Nangang District, Harbin, China
| | - Wenhao Wu
- School of Health Management, Harbin Medical University, 157 Baojian Road, Nangang District, Harbin, China
| | - Yan Wang
- School of Health Management, Harbin Medical University, 157 Baojian Road, Nangang District, Harbin, China
| | - Peiyan Ju
- School of Health Management, Harbin Medical University, 157 Baojian Road, Nangang District, Harbin, China
| | - Xin Zhang
- School of Health Management, Harbin Medical University, 157 Baojian Road, Nangang District, Harbin, China.
| | - Guoxiang Liu
- School of Health Management, Harbin Medical University, 157 Baojian Road, Nangang District, Harbin, China.
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Abstract
BACKGROUND Over the past twenty years explicit gender bias towards women in surgery has been replaced by more subtle barriers, which represent indirect forms of discrimination and prevents equality. OBJECTIVE The aim of our scoping review is to summarize the different forms of discrimination towards women in surgery. METHODS The database search consisted of original studies regarding discrimination towards female surgeons. RESULTS Of 3,615 studies meeting research criteria, 63 were included. Of these articles, 11 (18%) were focused on gender-based discrimination, 14 (22%) on discrimination in authorship, research productivity and research funding, 21 (33%) on discrimination in academic surgery, 7 (11%) on discrimination in surgical leadership positions and 10 (16%) on discrimination during conferences and in surgical societies. The majority (n = 53, 84%) of the included studies were conducted in the U.S.A. According to our analysis, female surgeons experience discrimination from male colleagues, healthcare workers, but also from patients and trainees. Possible solutions may include acknowledgement of the problem, increased education of diversity and integration for the younger generations, mentorship, coaching and more active engagement by male and female partners to support women in the surgical field. CONCLUSIONS Gender-based discrimination toward women in the field of surgery has evolved over the past twenty years, from an explicit to a more subtle attitude. A work-environment where diversity and flexibility are valued would allow female surgeons to better realize their full potential.
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Takasu C, Kono E, Morine Y, Yoshikawa K, Tokunaga T, Nishi M, Kashihara H, Yoshimoto T, Yamashita S, Shimada M. A "diversity and inclusion" lecture for promoting self-awareness among medical students. Surg Today 2022; 52:964-970. [PMID: 35001195 DOI: 10.1007/s00595-021-02424-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Accepted: 09/22/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE The concept of 'diversity and inclusion' is being adopted worldwide, but it is not yet understood well in Japan. We conducted this study to evaluate the impact of a lecture aimed at increasing awareness of academic careers and the benefits of having diversity and inclusion. METHODS Two female surgeons delivered a 120-min lecture on "diversity and inclusion" to third-year medical students at Tokushima University. To assess the impact of the lecture, a questionnaire was distributed, for participants to complete anonymously before and after the lecture. RESULTS Eighty-two students participated in the study (39 men, 38 women, and 5 unknown). Based on the questionnaire responses, 57.1% of the students had already perceived inequality in conduct because of gender. A comparison of pre- and post-lecture responses revealed a significant increase in confidence to succeed in their medical career (56.5% vs. 77.5%, p < 0.01). Learners were more likely to believe that gender would not become a barrier to career development (42.4% vs. 66.7%, p < 0.01). Moreover, 90.4% of the students felt positively about a career in surgery following the lecture. CONCLUSION The lecture promoted awareness about diversity, self-awareness, and career development and motivated students to consider specializing in surgery later in their career.
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Affiliation(s)
- Chie Takasu
- Department of Surgery, Institute of Health Biosciences, Tokushima University, Kuramoto 3-18-15, Tokushima, 770-8503, Japan.
| | - Emiko Kono
- Department of General and Gastroenterological Surgery, Osaka Medical and Pharmaceutical University, Takatsuki, Japan
| | - Yuji Morine
- Department of Surgery, Institute of Health Biosciences, Tokushima University, Kuramoto 3-18-15, Tokushima, 770-8503, Japan
| | - Kozo Yoshikawa
- Department of Surgery, Institute of Health Biosciences, Tokushima University, Kuramoto 3-18-15, Tokushima, 770-8503, Japan
| | - Takuya Tokunaga
- Department of Surgery, Institute of Health Biosciences, Tokushima University, Kuramoto 3-18-15, Tokushima, 770-8503, Japan
| | - Masaaki Nishi
- Department of Surgery, Institute of Health Biosciences, Tokushima University, Kuramoto 3-18-15, Tokushima, 770-8503, Japan
| | - Hideya Kashihara
- Department of Surgery, Institute of Health Biosciences, Tokushima University, Kuramoto 3-18-15, Tokushima, 770-8503, Japan
| | - Toshiaki Yoshimoto
- Department of Surgery, Institute of Health Biosciences, Tokushima University, Kuramoto 3-18-15, Tokushima, 770-8503, Japan
| | - Shoko Yamashita
- Department of Surgery, Institute of Health Biosciences, Tokushima University, Kuramoto 3-18-15, Tokushima, 770-8503, Japan
| | - Mitsuo Shimada
- Department of Surgery, Institute of Health Biosciences, Tokushima University, Kuramoto 3-18-15, Tokushima, 770-8503, Japan
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18
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Schizas D, Papapanou M, Routsi E, Mastoraki A, Lidoriki I, Zavras N, Avgerinos DV, Lazaris AM, Tsaroucha A. Career barriers for women in surgery. Surgeon 2022; 20:275-283. [PMID: 34996719 DOI: 10.1016/j.surge.2021.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 11/09/2021] [Accepted: 11/29/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Despite the increasing numbers of female medical students, surgery remains male-dominated. PURPOSE To highlight the principal career obstacles experienced by aspiring female surgeons. METHODS A narrative review of literature on the position and career barriers of female surgeons has been conducted, using the MEDLINE and EMBASE databases. MAIN FINDINGS Implicit and even explicit biases against female surgeons remain prevalent, negatively impacting their training performance and overall professional trajectory. Female surgeons are globally underrepresented in leadership positions and senior academic rankings, especially that of a full professor. They feel hampered by lack of effective mentorship, whose value for a successful career has been acknowledged by all medical students, surgeons and surgical leaders. Their work-life imbalance is sometimes expressed as lower likelihood than their male contemporaries of getting married or having children and may be attributed to their conventional association with the role of caretaker, their personal desire to accommodate occupational and family duties and the inadequate implementation of parental leave and childcare policies. Female surgeons' "infertility" may be further explained by direct and indirect pregnancy-related difficulties. Female surgeons are also financially undercompensated compared to their male contemporaries. Finally, specialty-specific challenges should not be overlooked. CONCLUSIONS While encouraging steps have been made, women in surgery feel still hindered by various obstacles. The qualitative, interview-based nature of current literature requires more meticulous studies on these barriers with a more quantitative and objective approach. Attenuation of gender imbalance in surgical specialties requires further changes in mentality and more targeted modifications in relevant policies.
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Affiliation(s)
- Dimitrios Schizas
- First Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
| | - Michail Papapanou
- First Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece.
| | - Eleni Routsi
- First Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
| | - Aikaterini Mastoraki
- First Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
| | - Irene Lidoriki
- First Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
| | - Nikolaos Zavras
- Department of Pediatric Surgery, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece
| | - Dimitrios V Avgerinos
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, NewYork Presbyterian, New York, NY, United States
| | - Andreas M Lazaris
- Department of Vascular Surgery, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece
| | - Alexandra Tsaroucha
- Second Department of Surgery and Laboratory of Experimental Surgery, Democritus University of Thrace, Alexandroupolis, Greece
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Methangkool E, Brodt J, Kolarczyk L, Ivascu NS, Hicks MH, Herrera E, Oakes D. Perceptions of Gender Disparities Among Women in Cardiothoracic Anesthesiology. J Cardiothorac Vasc Anesth 2021; 36:1859-1866. [PMID: 34903458 DOI: 10.1053/j.jvca.2021.11.015] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 11/05/2021] [Accepted: 11/07/2021] [Indexed: 11/11/2022]
Abstract
OBJECTIVE In this study of women in cardiothoracic anesthesiology, the authors aimed to characterize demographics, roles in leadership, and perceived professional challenges. DESIGN A prospective cross-sectional survey of female cardiothoracic anesthesiologists in the United States. SETTING An internet-based survey of 43 questions was sent to women in cardiothoracic anesthesiology. The survey included questions on demographics, leadership, and perceptions of professional challenges including career advancement, compensation, promotion, harassment, and intimidation. PARTICIPANTS A database of women in cardiothoracic anesthesiology was created via personal contacts and snowball sampling. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS A total of 153 responses were analyzed, for a response rate of 65.1%. Most respondents were at the Clinical Instructor or Assistant Professor rank. Many women perceived that compensation, promotion, authorship, and career advancement were affected by gender. Furthermore, 67% of respondents identified having children as having a negative impact on career advancement. Many women reported experiencing derogatory comments (55.6%), intimidation (57.8%), microaggression (69.6%), sexual harassment (25.2%), verbal harassment (45.2%), and unwanted physical or sexual advances (24.4%). These behaviors were most often from a surgical attending, anesthesia attending, or patient. CONCLUSION This survey study of women in cardiothoracic anesthesiology found that many women perceived inequities in financial compensation, authorship opportunities, and promotion; in addition, many felt that their career advancement was impacted negatively by having children. A striking finding was that the majority of women have experienced intimidation, derogatory comments, and microaggressions in the workplace.
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Affiliation(s)
- Emily Methangkool
- Department of Anesthesiology and Perioperative Medicine, University of California, Los Angeles, Los Angeles, CA.
| | - Jessica Brodt
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University, Stanford, CA
| | - Lavinia Kolarczyk
- Department of Anesthesiology, University of North Carolina, Chapel Hill, NC
| | - Natalia S Ivascu
- Department of Anesthesiology, Weill Cornell Medical College, New York, NY
| | - Megan H Hicks
- Department of Anesthesiology, Wake Forest School of Medicine, Winston-Salem, NC
| | - Elizabeth Herrera
- Department of Anesthesiology, Houston Methodist Hospital, Houston, TX
| | - Daryl Oakes
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University, Stanford, CA
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The Role of Gender in Careers in Medicine: a Systematic Review and Thematic Synthesis of Qualitative Literature. J Gen Intern Med 2021; 36:2392-2399. [PMID: 33948802 PMCID: PMC8342686 DOI: 10.1007/s11606-021-06836-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Accepted: 04/15/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Gender disparities exist in the careers of women in medicine. This review explores the qualitative literature to understand how gender influences professional trajectories, and identify opportunities for intervention. METHODS A systematic review and thematic synthesis included articles obtained from PubMed, Cochrane Central Register of Controlled Trials (Ovid), EMBASE (Ovid), APA PsycInfo (Ovid), and GenderWatch (ProQuest) on June 26 2020, updated on September 10, 2020. Included studies explored specialty choice, leadership roles, practice setting, burnout, promotion, stigma, mentoring, and organizational culture. Studies taking place outside of the USA, using only quantitative data, conducted prior to 2000, or focused on other health professions were excluded. Data were extracted using a standardized extraction tool and assessed for rigor and quality using a 9-item appraisal tool. A three-step process for thematic synthesis was used to generate analytic themes and construct a conceptual model. The study is registered with PROSPERO (CRD42020199999). FINDINGS Among 1524 studies identified, 64 were eligible for analysis. Five themes contributed to a conceptual model for the influence of gender on women's careers in medicine that resembles a developmental socio-ecological model. Gender influences career development externally through culture which valorizes masculine stereotypes and internally shapes women's integration of personal and professional values. CONCLUSION Medical culture and structures are implicitly biased against women. Equitable environments in education, mentoring, hiring, promotion, compensation, and support for work-life integration are needed to address gender disparities in medicine. Explicit efforts to create inclusive institutional cultures and policies are essential to support a diverse workforce.
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Marks IH, Diaz A, Keem M, Ladi-Seyedian SS, Philipo GS, Munir H, Pomerani TI, Sughayer HM, Peter N, Lavy C, Chang DC. Barriers to Women Entering Surgical Careers: A Global Study into Medical Student Perceptions. World J Surg 2020; 44:37-44. [PMID: 31616970 DOI: 10.1007/s00268-019-05199-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Barriers to female surgeons entering the field are well documented in Australia, the USA and the UK, but how generalizable these problems are to other regions remains unknown. METHODS A cross-sectional survey was developed by the International Federation of Medical Students' Associations (IFMSA)'s Global Surgery Working Group assessing medical students' desire to pursue a surgical career at different stages of their medical degree. The questionnaire also included questions on students' perceptions of their education, resources and professional life. The survey was distributed via IFMSA mailing lists, conferences and social media. Univariate analysis was performed, and statistically significant exposures were added to a multivariate model. This model was then tested in male and female medical students, before a further subset analysis by country World Bank income strata. RESULTS 639 medical students from 75 countries completed the survey. Mentorship [OR 3.42 (CI 2.29-5.12) p = 0.00], the acute element of the surgical specialties [OR 2.22 (CI 1.49-3.29) p = 0.00], academic competitiveness [OR 1.61 (CI 1.07-2.42) p = 0.02] and being from a high or upper-middle-income country (HIC and UMIC) [OR 1.56 (CI 1.021-2.369) p = 0.04] all increased likelihood to be considering a surgical career, whereas perceived access to postgraduate training [OR 0.63 (CI 0.417-0.943) p = 0.03], increased year of study [OR 0.68 (CI 0.57-0.81) p = 0.00] and perceived heavy workload [OR 0.47 (CI 0.31-0.73) p = 0.00] all decreased likelihood to consider a surgical career. Perceived quality of surgical teaching and quality of surgical services in country overall did not affect students' decision to pursue surgery. On subset analysis, perceived poor access to postgraduate training made women 60% less likely to consider a surgical career [OR 0.381 (CI 0.217-0.671) p = 0.00], whilst not showing an effect in the men [OR 1.13 (CI 0.61-2.12) p = 0.70. Concerns about high cost of training halve the likelihood of students from low and low-middle-income countries (LICs and LMICs) considering a surgical career [OR 0.45 (CI 0.25-0.82) p = 0.00] whilst not demonstrating a significant relationship in HIC or UMIC countries. Women from LICs and LMICs were 40% less likely to consider surgical careers than men, when controlling for other factors [OR 0.59 CI (0.342-1.01 p = 0.053]. CONCLUSION Perceived poor access to postgraduate training and heavy workload dissuade students worldwide from considering surgical careers. Postgraduate training in particular appears to be most significant for women and cost of training an additional factor in both women and men from LMICs and LICs. Mentorship remains an important and modifiable factor in influencing student's decision to pursue surgery. Quality of surgical education showed no effect on student decision-making.
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Affiliation(s)
- I H Marks
- Department of Primary Care and Public Health, Imperial College, London, UK.
| | - A Diaz
- Virginia Commonwealth University School of Medicine, Richmond, VA, USA
| | - M Keem
- Royal Melbourne Hospital, Melbourne, Australia
| | | | - G S Philipo
- School of International Education, Southern Medical University, Guangzhou, China
| | - H Munir
- Jinnah Hospital, Lahore, Pakistan
| | - T I Pomerani
- Medicine and Surgery, School of Human Health Sciences, University of Florence, Florence, Italy
| | - H M Sughayer
- Faculty of Medicine, Al-Quds University, East Jerusalem, Palestine
| | - N Peter
- Nuffield Department of Orthopaedics Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - C Lavy
- Nuffield Department of Orthopaedics Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - D C Chang
- Department of Surgery, Massachusetts General Hospital, Boston, USA
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Surgical job negotiations: How current literature and expert opinion can inform your strategies. Am J Surg 2020; 220:1201-1207. [DOI: 10.1016/j.amjsurg.2020.06.049] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 05/01/2020] [Accepted: 06/25/2020] [Indexed: 11/22/2022]
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Xepoleas MD, Munabi NCO, Auslander A, Magee WP, Yao CA. The experiences of female surgeons around the world: a scoping review. HUMAN RESOURCES FOR HEALTH 2020; 18:80. [PMID: 33115509 PMCID: PMC7594298 DOI: 10.1186/s12960-020-00526-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 10/15/2020] [Indexed: 05/25/2023]
Abstract
INTRODUCTION The Lancet Commission for Global Surgery identified an adequate surgical workforce as one indicator of surgical care accessibility. Many countries where women in surgery are underrepresented struggle to meet the recommended 20 surgeons per 100,000 population. We evaluated female surgeons' experiences globally to identify strategies to increase surgical capacity through women. METHODS Three database searches identified original studies examining female surgeon experiences. Countries were grouped using the World Bank income level and Global Gender Gap Index (GGGI). RESULTS Of 12,914 studies meeting search criteria, 139 studies were included and examined populations from 26 countries. Of the accepted studies, 132 (95%) included populations from high-income countries (HICs) and 125 (90%) exclusively examined populations from the upper 50% of GGGI ranked countries. Country income and GGGI ranking did not independently predict gender equity in surgery. Female surgeons in low GGGI HIC (Japan) were limited by familial support, while those in low income, but high GGGI countries (Rwanda) were constrained by cultural attitudes about female education. Across all populations, lack of mentorship was seen as a career barrier. HIC studies demonstrate that establishing a critical mass of women in surgery encourages female students to enter surgery. In HICs, trainee abilities are reported as equal between genders. Yet, HIC women experience discrimination from male co-workers, strain from pregnancy and childcare commitments, and may suffer more negative health consequences. Female surgeon abilities were seen as inferior in lower income countries, but more child rearing support led to fewer women delaying childbearing during training compared to North Americans and Europeans. CONCLUSION The relationship between country income and GGGI is complex and neither independently predict gender equity. Cultural norms between geographic regions influence the variability of female surgeons' experiences. More research is needed in lower income and low GGGI ranked countries to understand female surgeons' experiences and promote gender equity in increasing the number of surgical providers.
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Affiliation(s)
- Meredith D. Xepoleas
- Division of Plastic and Maxillofacial Surgery, Children’s Hospital Los Angeles, Los Angeles, CA USA
- Operation Smile Inc, Virginia Beach, Virginia Beach, VA USA
| | - Naikhoba C. O. Munabi
- Operation Smile Inc, Virginia Beach, Virginia Beach, VA USA
- Division of Plastic and Reconstructive Surgery, Keck School of Medicine, 1510 San Pablo St, Suite 415, Los Angeles, CA USA
| | - Allyn Auslander
- Division of Plastic and Maxillofacial Surgery, Children’s Hospital Los Angeles, Los Angeles, CA USA
| | - William P. Magee
- Division of Plastic and Maxillofacial Surgery, Children’s Hospital Los Angeles, Los Angeles, CA USA
- Operation Smile Inc, Virginia Beach, Virginia Beach, VA USA
- Division of Plastic and Reconstructive Surgery, Keck School of Medicine, 1510 San Pablo St, Suite 415, Los Angeles, CA USA
- Division of Plastic Surgery, Shriners Hospital for Children, Los Angeles, CA USA
| | - Caroline A. Yao
- Operation Smile Inc, Virginia Beach, Virginia Beach, VA USA
- Division of Plastic and Reconstructive Surgery, Keck School of Medicine, 1510 San Pablo St, Suite 415, Los Angeles, CA USA
- Division of Plastic Surgery, Shriners Hospital for Children, Los Angeles, CA USA
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Hoffman R, Mullan J, Nguyen M, Bonney AD. Motherhood and medicine: systematic review of the experiences of mothers who are doctors. Med J Aust 2020; 213:329-334. [PMID: 32865236 DOI: 10.5694/mja2.50747] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Accepted: 03/03/2020] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To synthesise what is known about women combining motherhood and a career in medicine by examining the published research into their experiences and perspectives. STUDY DESIGN We reviewed peer-reviewed articles published or available in English reporting original research into motherhood and medicine and published during 2008-2019. Two researchers screened each abstract and independently reviewed full text articles. Study quality was assessed. DATA SOURCES CINAHL, MEDLINE, PsycINFO, Web of Science, and Scopus abstract databases. DATA SYNTHESIS The database search identified 4200 articles; after screening and full text assessment, we undertook an integrative review synthesis of the 35 articles that met our inclusion criteria. CONCLUSIONS Three core themes were identified: Motherhood: the impact of being a doctor on raising children; Medicine: the impact of being a mother on a medical career; and Combining motherhood and medicine: strategies and policies. Several structural and attitudinal barriers to women pursuing both medical careers and motherhood were identified. It was often reported that women prioritise career advancement by delaying starting a family, and that female doctors believed that career progression would be slowed by motherhood. Few evaluations of policies for supporting pregnant doctors, providing maternity leave, and assisting their return to work after giving birth have been published. We did not find any relevant studies undertaken in Australia or New Zealand, nor any studies with a focus on community-based medicine or intervention studies. Prospective investigations and rigorous evaluations of policies and support mechanisms in different medical specialties would be appropriate. PROTOCOL REGISTRATION PROSPERO CRD42019116228.
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Affiliation(s)
- Rebekah Hoffman
- Graduate School of Medicine, University of Wollongong, Wollongong, NSW
| | - Judy Mullan
- Graduate School of Medicine, University of Wollongong, Wollongong, NSW
| | - Marisa Nguyen
- Graduate School of Medicine, University of Wollongong, Wollongong, NSW
| | - Andrew D Bonney
- Graduate School of Medicine, University of Wollongong, Wollongong, NSW
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Chow CJ, Millar MM, López AM. Gender Discrimination Among Academic Physicians. WOMEN'S HEALTH REPORTS 2020; 1:203-211. [PMID: 32789303 PMCID: PMC7416626 DOI: 10.1089/whr.2020.0031] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 05/01/2020] [Indexed: 01/22/2023]
Abstract
Background: There is a growing body of literature showing that gender discrimination impacts physicians' work and life experiences. Impact on income, promotion, and parenthood has been documented. Based on these findings, we hypothesized that the experiences of academic physicians who identify as women or gender nonconforming would be different from their counterparts who are men. This survey study explores the influences of gender on academic physicians' experiences with discrimination in life and at work. Materials and Methods: In the spring of 2017, academic physicians (n = 752) at a medical school in the West were invited to participate in a survey that measured experiences with discrimination using the Everyday Discrimination Scale and additional items. We used a mixed-methods approach to analyze the data, employing chi square and t-tests to analyze quantitative data and modified content analysis to code open-ended responses. Results: The response rate was 24% (180/752). There was no significant difference between women and men in reported frequency of discrimination in everyday life (p = 0.474). However, women were significantly more likely than men to select gender as a reason for being treated differently in everyday life (p = 0.000) and report discrimination in the workplace (p < 0.000). Open-ended responses describing experiences of discrimination differed based on gender: women were twice as likely than men to report receiving negative treatment owing to gender. Finally, men discussed having gender privilege, whereas women discussed experiencing gender discrimination. Conclusions: This study contributes to the growing body of literature about how gender influences the experience of practicing medicine.
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Affiliation(s)
- Candace J Chow
- Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Morgan M Millar
- Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Ana María López
- Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah, USA
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Shaikh S, Malik A, Boneva D, Hai S, McKenney M, Elkbuli A. Current Trends of Women Surgeon Speakers at National Trauma Surgery Conferences: The Trauma House Is Improving. Am Surg 2020; 86:803-810. [PMID: 32683920 DOI: 10.1177/0003134820933555] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND An invitation to speak at a national meeting represents the advancement of one's career and indicates acceptance and the attention of the scientific community. Studies have revealed gender disparities across medical and surgical society meetings. The purpose of our study was to assess the current trend of women surgeon speakers at major national trauma surgery conferences during the last 4 years (ie, 2016-2019). METHODS A retrospective analysis of conference programs of major trauma surgery association annual meetings including the American Association for the Surgery of Trauma (AAST), the Eastern Association for the Surgery of Trauma (EAST), and the Western Trauma Association (WTA) was conducted. Our primary outcome was the number and proportion of women surgeon speakers at each conference each year. RESULTS Twelve conference programs from three national trauma surgery association annual meetings were reviewed. A total of 2029 speakers were included; 608 (30%) of which were female and 1421 (70%) of which were male. The proportion of women speakers ranged from 22.3% to 41.4%. The number of women speakers increased each year from 2016 to 2019: (EAST: 25.2%-39.8%, P = .049; AAST: 27.1%-41.4%, P < .00001, and WTA: 27.8%-33.3%, P = . 0.573). CONCLUSION The number of women surgeon speakers at national trauma surgery conferences significantly increased from 2016 to 2019. The increase in women trauma surgeon speakers is encouraging and should be celebrated, but organizational leadership should take this information into account while extending invitations to surgeons for speaking opportunities and continue to promote diversity and inclusivity.
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Affiliation(s)
- Saamia Shaikh
- 14506Department of Surgery, Kendall Regional Medical Center, Miami, FL, USA
| | - Ameena Malik
- 14506Department of Surgery, Kendall Regional Medical Center, Miami, FL, USA
| | - Dessy Boneva
- 14506Department of Surgery, Kendall Regional Medical Center, Miami, FL, USA.,University of South Florida, Tampa, FL, USA
| | - Shaikh Hai
- 14506Department of Surgery, Kendall Regional Medical Center, Miami, FL, USA
| | - Mark McKenney
- 14506Department of Surgery, Kendall Regional Medical Center, Miami, FL, USA.,University of South Florida, Tampa, FL, USA
| | - Adel Elkbuli
- 14506Department of Surgery, Kendall Regional Medical Center, Miami, FL, USA
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Marks IH, Diaz A, Keem M, Ladi-Seyedian SS, Philipo GS, Munir H, Pomerani TI, Sughayer HM, Peter N, Lavy C, Chang DC. Barriers to Women Entering Surgical Careers: A Global Study into Medical Student Perceptions. World J Surg 2019. [PMID: 31616970 DOI: 10.1007/s00268-019-05199-1.] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Barriers to female surgeons entering the field are well documented in Australia, the USA and the UK, but how generalizable these problems are to other regions remains unknown. METHODS A cross-sectional survey was developed by the International Federation of Medical Students' Associations (IFMSA)'s Global Surgery Working Group assessing medical students' desire to pursue a surgical career at different stages of their medical degree. The questionnaire also included questions on students' perceptions of their education, resources and professional life. The survey was distributed via IFMSA mailing lists, conferences and social media. Univariate analysis was performed, and statistically significant exposures were added to a multivariate model. This model was then tested in male and female medical students, before a further subset analysis by country World Bank income strata. RESULTS 639 medical students from 75 countries completed the survey. Mentorship [OR 3.42 (CI 2.29-5.12) p = 0.00], the acute element of the surgical specialties [OR 2.22 (CI 1.49-3.29) p = 0.00], academic competitiveness [OR 1.61 (CI 1.07-2.42) p = 0.02] and being from a high or upper-middle-income country (HIC and UMIC) [OR 1.56 (CI 1.021-2.369) p = 0.04] all increased likelihood to be considering a surgical career, whereas perceived access to postgraduate training [OR 0.63 (CI 0.417-0.943) p = 0.03], increased year of study [OR 0.68 (CI 0.57-0.81) p = 0.00] and perceived heavy workload [OR 0.47 (CI 0.31-0.73) p = 0.00] all decreased likelihood to consider a surgical career. Perceived quality of surgical teaching and quality of surgical services in country overall did not affect students' decision to pursue surgery. On subset analysis, perceived poor access to postgraduate training made women 60% less likely to consider a surgical career [OR 0.381 (CI 0.217-0.671) p = 0.00], whilst not showing an effect in the men [OR 1.13 (CI 0.61-2.12) p = 0.70. Concerns about high cost of training halve the likelihood of students from low and low-middle-income countries (LICs and LMICs) considering a surgical career [OR 0.45 (CI 0.25-0.82) p = 0.00] whilst not demonstrating a significant relationship in HIC or UMIC countries. Women from LICs and LMICs were 40% less likely to consider surgical careers than men, when controlling for other factors [OR 0.59 CI (0.342-1.01 p = 0.053]. CONCLUSION Perceived poor access to postgraduate training and heavy workload dissuade students worldwide from considering surgical careers. Postgraduate training in particular appears to be most significant for women and cost of training an additional factor in both women and men from LMICs and LICs. Mentorship remains an important and modifiable factor in influencing student's decision to pursue surgery. Quality of surgical education showed no effect on student decision-making.
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Affiliation(s)
- I H Marks
- Department of Primary Care and Public Health, Imperial College, London, UK.
| | - A Diaz
- Virginia Commonwealth University School of Medicine, Richmond, VA, USA
| | - M Keem
- Royal Melbourne Hospital, Melbourne, Australia
| | | | - G S Philipo
- School of International Education, Southern Medical University, Guangzhou, China
| | - H Munir
- Jinnah Hospital, Lahore, Pakistan
| | - T I Pomerani
- Medicine and Surgery, School of Human Health Sciences, University of Florence, Florence, Italy
| | - H M Sughayer
- Faculty of Medicine, Al-Quds University, East Jerusalem, Palestine
| | - N Peter
- Nuffield Department of Orthopaedics Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - C Lavy
- Nuffield Department of Orthopaedics Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - D C Chang
- Department of Surgery, Massachusetts General Hospital, Boston, USA
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International and Geographic Trends in Gender Authorship within Plastic Surgery. Plast Reconstr Surg 2019; 144:1010-1016. [PMID: 31568321 DOI: 10.1097/prs.0000000000006076] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Professional advancement in academic plastic surgery may depend on scholarly activity. The authors evaluate gender-based publishing characteristics in three international plastic surgery journals. METHODS A retrospective review of all articles published in 2016 in the following journals was undertaken: Plastic and Reconstructive Surgery, Journal of Plastic, Reconstructive and Aesthetic Surgery, European Journal of Plastic Surgery, Annals of Surgery, and New England Journal of Medicine. Data were collected on lead author gender (first or senior author) and differences in author gender proportions, by journal, by article topic, and by geographic location were evaluated. RESULTS Overall, 2610 articles were retrieved: 34.1 percent were from plastic surgery journals, 12.8 percent were from the Annals of Surgery, and 53.1 percent were from the New England Journal of Medicine. There was a lower proportion of female lead authors among plastic surgery journals compared with the Annals of Surgery and the New England Journal of Medicine (31 percent versus 39 percent versus 39 percent; p = 0.001). There were no differences in female lead author geographic location in the Annals of Surgery or the New England Journal of Medicine; within the plastic surgery journals, there were differences (p = 0.005), including a lower proportion arising from East Asia (15 percent) and a higher proportion arising from Canada (48 percent). Within plastic surgery, Plastic and Reconstructive Surgery had the lowest proportion of female lead author (p < 0.001). The proportion of female lead author varied by article topic (p < 0.001) and was notably higher in breast (45.6 percent) and lower in head and neck/craniofacial-orientated articles (25.0 percent). CONCLUSIONS There are gender disparities in three mainstream plastic surgery journals-Plastic and Reconstructive Surgery, the Journal of Plastic, Reconstructive and Aesthetic Surgery, the European Journal of Plastic Surgery-and there are lower proportions of lead female authorship compared with the Annals of Surgery and the New England Journal of Medicine. Further research should focus on understanding any geographic disparities that may exist.
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The Shillam-Clipper Leadership Minimum Demographic Data Set: A Tool for Advancing Healthcare Research. J Nurs Adm 2019; 49:496-502. [PMID: 31517757 DOI: 10.1097/nna.0000000000000793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The purpose of this research study was to develop an innovative, standardized taxonomy for leader demographic data to gather consistent and comparable data across healthcare leadership studies. BACKGROUND Minimum data sets help ensure consistent data collection strategies for standardized comparison among similar variables across settings. A standardized approach to collecting demographic data of healthcare workforce leadership will provide the structure necessary for researchers to more adequately compare the role of demographic characteristics in research outcomes. METHODS This study was conducted using systematic literature review methodology with comparative analysis across demographic data sets. Two separate literature reviews were conducted: the 1st for studies of approaches to establishing minimum data sets and another for studies of healthcare leadership. RESULTS The outcome of this study is the Shillam-Clipper Leadership Minimum Demographic Data Set tool that includes a comprehensive list of minimum demographic variables applicable to healthcare leadership research, a glossary of operational definitions for the identified demographic variables, and a clearly articulated set of instructions for consistent and accurate data collection. CONCLUSION This standardized taxonomy will result in a consistent data set that will improve the effectiveness of comparative research.
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Mohan H, Ali O, Gokani V, McGoldrick C, Smitham P, Fitzgerald JEF, Harries R. Surgical trainees' experience of pregnancy, maternity and paternity leave: a cross-sectional study. Postgrad Med J 2019; 95:552-557. [PMID: 31375558 DOI: 10.1136/postgradmedj-2018-135952] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 06/17/2019] [Accepted: 06/28/2019] [Indexed: 11/04/2022]
Abstract
BACKGROUND Internationally, supporting surgical trainees during pregnancy, maternity and paternity leave is essential for trainee well-being and for retention of high-calibre surgeons, regardless of their parental status. This study sought to determine the current experience of surgical trainees regarding pregnancy, maternity and paternity leave. METHODS A cross-sectional anonymised electronic voluntary survey of all surgical trainees working in the UK and Ireland was distributed via the Association of Surgeons in Training and the British Orthopaedic Trainees' Association. RESULTS There were 876 complete responses, of whom 61.4% (n=555) were female. 46.5% (258/555) had been pregnant during surgical training. The majority (51.9%, n=134/258) stopped night on-call shifts by 30 weeks' gestation. The most common reason for this was concerns related to tiredness and maternal health. 41% did not have rest facilities available on night shifts. 27.1% (n=70/258) of trainees did not feel supported by their department during pregnancy, and 17.1% (n=50/258) found the process of arranging maternity leave difficult or very difficult. 61% (n=118/193) of trainees felt they had returned to their normal level of working within 6 months of returning to work after maternity leave, while a significant minority took longer. 25% (n=33/135) of trainees found arranging paternity leave difficult or very difficult, and the most common source of information regarding paternity leave was other trainees. CONCLUSION Over a quarter of surgical trainees felt unsupported by their department during pregnancy, while a quarter of male trainees experience difficulty in arranging paternity leave. Efforts must be made to ensure support is available in pregnancy and maternity/paternity leave.
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Affiliation(s)
- Helen Mohan
- Association of Surgeons in Training (ASiT), London, UK
| | - Oroog Ali
- Association of Surgeons in Training (ASiT), London, UK
| | - Vimal Gokani
- Association of Surgeons in Training (ASiT), London, UK
| | | | - Peter Smitham
- British Orthopaedic Trainees' Association (BOTA), London, UK
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Ellinas EH, Kaljo K, Patitucci TN, Novalija J, Byars-Winston A, Fouad NA. No Room to "Lean In": A Qualitative Study on Gendered Barriers to Promotion and Leadership. J Womens Health (Larchmt) 2018; 28:393-402. [PMID: 30481114 DOI: 10.1089/jwh.2018.7252] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION The gender gap in professorship and leadership roles persists in academic medicine, whereas reasons for these disparities remain unclear. MATERIALS AND METHODS Open-ended text responses to a 2013 faculty engagement survey were analyzed by using the grounded theory and consensual qualitative analysis techniques. The authors grouped 491 faculty's text responses into descriptive codes and three themes: (1) No Obstacles, (2) Barriers to Success, and (3) Concerns Regarding Processes. Demographics of codes were compared by using chi-square analysis. RESULTS Male faculty identified barriers that included negative views of leadership or leaders. Female faculty, especially those in clinical roles, expressed barriers related to role overload, including that the demands of their current positions prevented advancement or addition of further roles, no matter how desirable further roles may be. Women also shared that considerable self-promotion was required to receive acknowledgement of their work and support by leadership. CONCLUSION A proposed framework depicts male and female faculty's concerns on a continuum. No Obstacle and Process Concerns were relatively gender neutral, whereas large gender disparities occurred within the Barriers to Success theme. Women's barriers largely revolved around internal obstacles (I can't do any more), and men's barriers largely revolved around external factors (leaders are impeding my progress). Resources are needed to mitigate work overload specifically for female faculty, and to ensure that all faculty are both engaged in advanced career opportunities and encouraged to pursue leadership positions.
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Affiliation(s)
- Elizabeth H Ellinas
- 1 Department of Anesthesiology, Center for the Advancement of Women in Science and Medicine (AWSM), Medical College of Wisconsin , Milwaukee, Wisconsin
| | - Kristina Kaljo
- 2 Department of Obstetrics and Gynecology, Medical College of Wisconsin , Milwaukee, Wisconsin
| | - Teresa N Patitucci
- 3 Department of Cell Biology, Neurobiology, and Anatomy, Medical College of Wisconsin , Milwaukee, Wisconsin
| | - Jutta Novalija
- 4 Department of Anesthesiology, Medical Director of the Simulation Program, Milwaukee VAMC, Medical College of Wisconsin , Milwaukee, Wisconsin
| | - Angela Byars-Winston
- 5 Department of Medicine, Center for Women's Health Research, University of Wisconsin , Madison, Wisconsin
| | - Nadya A Fouad
- 6 Department of Educational Psychology, University of Wisconsin-Milwaukee , Milwaukee, Wisconsin
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Battaglia F, Shah S, Jalal S, Khurshid K, Verma N, Nicolaou S, Reddy S, John S, Khosa F. Gender disparity in academic emergency radiology. Emerg Radiol 2018; 26:21-28. [DOI: 10.1007/s10140-018-1642-7] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Accepted: 08/30/2018] [Indexed: 10/28/2022]
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Ellinas EH, Fouad N, Byars-Winston A. Women and the Decision to Leave, Linger, or Lean In: Predictors of Intent to Leave and Aspirations to Leadership and Advancement in Academic Medicine. J Womens Health (Larchmt) 2017; 27:324-332. [PMID: 29048981 DOI: 10.1089/jwh.2017.6457] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The Association of American Medical Colleges reports continued low rates of female faculty as professors and in leadership positions. While attrition and discrimination have both been proposed as explanations, recent literature has suggested that women's professional motivations, ingrained behavior, and perceptions of organizational support may also play a role. METHODS The authors employed a series of scales informed by the turnover theory (which predicts intent to leave an organization), previously validated and used in business and engineering studies, but rarely used in academic medicine. The authors proposed and tested a multiple regression model to assess predictors (role strain, work-life balance, and organizational climate) for three outcome variables: seeking promotion, seeking leadership, and intent to leave. RESULTS Survey results from 614 faculty members indicated that gender significantly influenced both promotion and leadership seeking, but not intent to leave. Perceived work-family conflict was negatively correlated with leadership seeking for women, but not for men. Positive views of organizational support and commitment were associated with promotion seeking and persistence for all participants. Role strain was positively correlated with desire for promotion and leadership, as well as with intent to leave. CONCLUSIONS Female faculty may not be leaning in to promotion and leadership roles because of increased role conflict, work-life concerns, and organizational factors; this seems to be more of a factor for female clinical rather than research faculty. Work-family conflict affects male and female faculty differently and should be addressed in efforts to retain faculty and to remove barriers for female faculty seeking leadership opportunities.
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Affiliation(s)
- Elizabeth H Ellinas
- 1 Department of Anesthesiology, Office of Faculty Affairs, Medical College of Wisconsin , Milwaukee, Wisconsin
| | - Nadya Fouad
- 2 Educational Psychology, University of Wisconsin-Milwaukee , Milwaukee, Wisconsin
| | - Angela Byars-Winston
- 3 Department of Medicine, UW Center for Women's Health Research, University of Wisconsin , Madison, Wisconsin
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Unique Challenges and Opportunities for Women in Interventional Pulmonology in 2017: The Door Is Open. J Bronchology Interv Pulmonol 2017; 24:260-262. [PMID: 28957886 DOI: 10.1097/lbr.0000000000000441] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Analysis of gender-based differences among surgeons in Japan: results of a survey conducted by the Japan Surgical Society. Part. 2: personal life. Surg Today 2017; 48:308-319. [PMID: 28921482 DOI: 10.1007/s00595-017-1586-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Accepted: 08/18/2017] [Indexed: 10/18/2022]
Abstract
PURPOSE To assess the true conditions and perceptions of the personal lives of men and women working as surgeons in Japan. METHODS In 2014, all e-mail subscribed members of the Japan Surgical Society (JSS, n = 29,861) were invited to complete a web-based survey. The questions covered demographic information, work environment, and personal life (including marital status, childcare, and nursing care for adult family members). RESULTS In total, 6211 surgeons (5586 men and 625 women) returned the questionnaires, representing a response rate of 20.8%. Based on the questionnaire responses, surgeons generally prioritize work and spend most of their time at work, although women with children prioritize their family over work; men spend significantly fewer hours on domestic work/childcare than do their female counterparts (men 0.76 h/day vs. women 2.93 h/day, p < 0.01); and both men and women surgeons, regardless of their age or whether they have children, place more importance on the role of women in the family. CONCLUSIONS The personal lives of Japanese surgeons differed significantly according to gender and whether they have children. The conservative idea that women should bear primary responsibility for the family still pertains for both men and women working as surgeons in Japan.
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Kawase K, Nomura K, Tominaga R, Iwase H, Ogawa T, Shibasaki I, Shimada M, Taguchi T, Takeshita E, Tomizawa Y, Nomura S, Hanazaki K, Hanashi T, Yamashita H, Kokudo N, Maeda K. Analysis of gender-based differences among surgeons in Japan: results of a survey conducted by the Japan Surgical Society. Part 1: Working style. Surg Today 2017. [PMID: 28634729 DOI: 10.1007/s00595-017-1556-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
PURPOSE To assess the working styles of men and women working as surgeons in Japan. METHODS In July, 2014, the Japan Surgical Society invited all their members (n = 29,861), through an internet campaign, to participate in a nationwide survey of surgeons. The items investigated in this descriptive study included demographic information and working styles, based on a questionnaire. RESULTS In total, 6211 surgeons participated (response rate 20.8%, 5586 men and 625 women). The largest age stratum was 40-49 years for men and 30-39 years for women. Overall, respondents identified their labor contract, including salary and work hours, as the highest priority for improvement. Women with children were more likely to be part-time employees, work fewer hours, and take fewer house calls/on-calls than their male counterparts. Moreover, women of all ages earned a lower annual income than men, irrespective of whether they had children. Perception scores for discrimination related to work and promotion were significantly higher among women than men (p < 0.01 and p = 0.011, respectively). CONCLUSIONS A significant difference in working style was observed between men and women working as surgeons in Japan.
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Affiliation(s)
- Kazumi Kawase
- Department of Surgery, The Jikei University School of Medicine Katsushika Medical Center, 6-41-2 Aoto, Katsushika-ku, Tokyo, 125-8506, Japan.
| | - Kyoko Nomura
- Department of Hygiene and Public Health, Teikyo University School of Medicine, Kaga 2-11-1, Itabashi, Tokyo, 173-8606, Japan
| | - Ryuji Tominaga
- Fukuoka Wajiro Hospital, 2-2-75 Wajirogaoka, Higashi-ku, Fukuoka, 811-0213, Japan
| | - Hirotaka Iwase
- Department of Breast and Endocrine Surgery, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556, Japan
| | - Tomoko Ogawa
- Department of Breast Surgery, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan
| | - Ikuko Shibasaki
- Department of Cardiac and Vascular Surgery, Dokkyo Medical University, 880 Kitakobayashi, Mibu, Tochigi, 321-0293, Japan
| | - Mitsuo Shimada
- Department of Surgery, Tokushima University, Kuramoto 3-18-15, Tokushima, Tokushima, 770-8503, Japan
| | - Tomoaki Taguchi
- Department of Pediatric Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, Fukuoka, 812-8582, Japan
| | - Emiko Takeshita
- Department of Surgery, Toho University Ohashi Medical Center, 2-17-6 Ohashi, Meguro-ku, Tokyo, 153-8585, Japan
| | - Yasuko Tomizawa
- Department of Cardiovascular Surgery, Tokyo Women's Medical University, 8-1 Kawada, Shinjuku-ku, Tokyo, 162-8666, Japan
| | - Sachiyo Nomura
- Department of Gastrointestinal Surgery, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Kazuhiro Hanazaki
- Department of Surgery, Kochi Medical School, Kochi University, Kohasu, Okocho, Nankoku, Kochi, 783-8505, Japan
| | - Tomoko Hanashi
- Department of Surgery, Tokai University Tokyo Hospital, 1-2-5 Yoyogi, Shibuya-ku, Tokyo, 151-0053, Japan
| | - Hiroko Yamashita
- Breast Surgery, Hokkaido University Hospital, Kita 14 Nishi 5, Kita-ku, Sapporo, 060-8648, Japan
| | - Norihiro Kokudo
- Hepatobiliary Pancreatic Surgery Division, Department of Surgery, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Kotaro Maeda
- Department of Surgery, Fujita Health University, 1-98 Denngakugakubo, Kutsukake, Toyoake, Aichi, 470-1192, Japan
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Fujimaki T, Shibui S, Kato Y, Matsumura A, Yamasaki M, Date I, Hongo K, Kuroda S, Matsumae M, Nakao N, Sakurada K, Shimokawa S, Kayama T. Working Conditions and Lifestyle of Female Surgeons Affiliated to the Japan Neurosurgical Society: Findings of Individual and Institutional Surveys. Neurol Med Chir (Tokyo) 2016; 56:704-708. [PMID: 27302300 PMCID: PMC5221781 DOI: 10.2176/nmc.oa.2016-0119] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
To investigate the working conditions of female neurosurgeons in Japan, two surveys were conducted by The Japan Neurosurgical Society: one involving female neurosurgeons themselves and the other involving the chiefs of neurosurgical departments. The responses were received from 224 (43.8%) female neurosurgeons and 496 (61.2%) departmental chiefs. About half (50.2%) of the female neurosurgeons were married and 39.2% had children (average number of children, 1.27). Their work was full-time in 80.6% of cases; on average, they worked 51.9 h per week, had night duty 2.8 times per month, and had 5.7 days off per month. Many of them stated that they were satisfied with their job status, but about half of them reported difficulty in maintaining a correct work–life balance. Among the institutions surveyed, 29% had female neurosurgeons. The survey of departmental chiefs revealed that the proxies for maternity leave were not available at most institutions, and that there was only limited availability of night child care (41%) or sick child care (39%); female neurosurgeons did not appear to be well-informed of these support systems. These findings suggest that apart from systematic approaches already in place, female neurosurgeons would prefer to have more understanding from their peers and chiefs.
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