The role of same-sex mentorship and organizational support in encouraging women to pursue surgery

A prospective cohort study on the role of surgical mentorship on medical students' surgical experience and attitudes towards surgery

BACKGROUND

Exposure to surgery during medical school is limited. We ran a mentorship scheme pairing students at a medical school with local surgeons to improve undergraduate insight. We evaluated the effectiveness of mentorship in increasing surgical exposure and drivers for students seeking surgical mentorship.

METHODS

35 surgeons across 7 specialties were recruited and matched with 37 students in years 2-4 for 7 months. Quantitative and qualitative evaluation was done with pre-, mid- and post-scheme questionnaires. Students rated confidence across pursuing a career in surgery, surgical exposure, career insight, understanding the application process, contacts, portfolio development, research knowledge and pursuing extra-curricular activities related to surgery using a 5-point Likert scale. Paired t-tests were performed to measure students' confidence before and after the scheme.

RESULTS

Of students that completed all 3 questionnaires (n = 21), conducting research/audit was most frequently selected as a main goal (81.0%), followed by theatre experience (66.7%) and career progression support (28.6%). The number of students that had assisted in theatre increased by 50.0%. Confidence ratings across all domains increased with 7/8 (87.5%) exhibiting a statistically significant improvement (p < 0.05). The greatest improvement was seen in having adequate contacts in surgery from 2.05 to 3.33 (p = 0.00). 95.2% would recommend the scheme.

CONCLUSIONS

Students gained significantly more surgical experience and were better equipped with the knowledge required to pursue a surgical career. Mentorship schemes are invaluable in supplementing the undergraduate curriculum and empowering students.

TRIAL REGISTRATION

Ethical clearance granted by King's College London Research Ethics Committee, Reference Number MRSU-22/23-34530. .

Evaluating the Role of Mentorship in Career Advancement: A Survey of Women in Academic Hand Surgery

PURPOSE

Despite the increasing percentage of women within the American Society for Surgery of the Hand, women remain underrepresented within leadership in academic hand surgery. Although this disparity in leadership representation may be improving, we aimed to investigate the role mentorship plays in advancing women in academic hand surgery.

METHODS

This is a survey-based, mixed-methods study. A written survey assessing themes in personal and professional experiences with mentorship was sent to hand fellowship-trained women. Inclusion criteria were the completion of a hand fellowship and current affiliation with an academic institution. An evolved grounded theory framework was used to evaluate the responses. Themes were identified based on common responses.

RESULTS

Of 186 eligible participants, 144 (85.2%) received the survey. The response rate was 48.6%. Respondents indicated that residency was the stage at which mentorship was most impactful (n = 25, 37%), and half of the respondents identified their desire to work in academic hand surgery during residency (n = 35, 50%). Obstacles to finding a mentor included lack of availability (n = 46, 67.7%), hesitance in searching for a mentor (n = 16, 23.5%), and searching for a mentor within an environment that was not conducive to success for trainees (n = 7, 10.3%). Most (84%) cited instances were the ones having the advice of a woman mentor was more impactful than that of a mentor who is a man. The reported need for same-sex mentorship fell into three categories: (1) insight into shared experiences, (2) assistance with conflict/bias management, and (3) support during career navigation.

CONCLUSIONS

The findings of this study demonstrate the need for high-quality mentorship during the residency with a specific emphasis on same-sex mentorship.

CLINICAL RELEVANCE

Our findings provide clear objectives related to improving access to and quality of mentorship. This foundational understanding will enrich mentor-mentee relationships, allowing for greater personal and professional success and satisfaction for both parties.

Gender Diversity Among Reconstructive Microsurgery Studies Based on the Relative Citation Ratio: An 18-Year Analysis

BACKGROUND

Gender disparities in plastic surgery authorship have been previously described in the literature. The relative citation ratio (RCR) index is a new metric that normalizes citation rates for field and time, which can be utilized to compare authors. This study aims to evaluate differences in gender authorship in reconstructive microsurgery (RM) papers, as well as the impact of gender on the RCR index.

METHODS

A PubMed query isolated RM studies between 2002 and 2020 across the 3 highest impact PS journals. Author names and RCR information were collected from NIH iCite. The likely gender was adjudicated by using NamSor-Software. Unpaired Wilcoxon rank-sum and chi-square tests were used to assess differences between groups.

RESULTS

Of 1146 articles (2172 authors), there was a significant difference between the proportion of females as senior authors compared to first authors ( P < 0.001). Overall, females represented 15.4% of all authors, 19.7% of first authors, and 11.3% of senior authors. Males had a significantly higher weighted RCR ( P < 0.0001) and number of publications ( P < 0.0001), which remained significant when stratified by first and senior author. Female authors collectively had a higher mean RCR ( P = 0.008) and among first authors ( P < 0.0001), with no significant difference among senior authors ( P = 0.47).

CONCLUSION

A considerably greater number of males are publishing in reconstructive microsurgery compared to females, with significantly more males being senior authors compared to first authors. Males had higher weighted RCR scores and publications compared to females. This study suggests that equity in gender authorship within the field is yet to be achieved.

You Can't Be What You Can't See: The Progression of Women in Otolaryngology-Head and Neck Surgery

Objective: To examine trends in the gender composition of residents and faculty in Otolaryngology-Head and Neck Surgery residency programs in the United States and to investigate the correlation between women's representation in leadership positions and the proportion of women faculty and residents. Methods: A literature review was first performed to analyze trends in the gender composition of residents and faculty in Otolaryngology-Head and Neck Surgery (OHNS) residency programs. Current residency programs were then identified using the Electronic Residency Application Service 2023 Participating Specialties and Programs website. The following data was collected from each program website: gender of associated medical school dean, gender of department chair, gender of residency program director, and total number and gender of fellowship directors, faculty, and residents. Wilcoxon rank sum test and Fischer's exact test were used to analyze relationships between the number of women in leadership positions and the proportion of women faculty and residents. Results: An increase in the number of women chairs, residency program directors, residents, and faculty over the past decade is documented across published literature. One hundred twenty-three current academic residency programs were identified. Women accounted for 42%, 30%, 27%, and 8% of current residents, residency program directors, faculty, and department chairs, respectively. Department chair gender was significantly correlated with number of women faculty (P = .01). Any women in a leadership position were correlated with a statistically significant increase in median percent of women faculty (P = .006). Conclusion: Further understanding of how the mentorship of women promotes gender equity is necessary to promote gender diversity in OHNS.

Gender-Related Disparities Among Vascular Surgeons in Italy: Results from a Cross-Sectional Survey

BACKGROUND

To assess the presence, quality and impact of gender-related discrepancies in academic vascular surgery at a national level.

METHODS

This was an anonymous national structured nonvalidated cross-sectional survey on gender disparity perceptions, named "I love it when you call me Señorita", distributed to 645 participants from academic Italian vascular centers. Endpoints were related to job-related characteristics, satisfaction, and sexual harassment.

RESULTS

The survey yielded a 27% response rate (n = 174, 78 males and 96 females). Significant differences between male and female responders were found in terms of job satisfaction (83.3% vs. 53.1%, P < 0.001), perception of career opportunities (91.7% vs. 67.9%, P < 0.001), surgical activity in the operating theater (34.6% vs. 7.3%, P < 0.001), involvement in scientific activities (contribution in peer-reviewed articles: 37.2% vs. 9.4%, P < 0.001; scientific meeting attendance/year: 42.3% vs. 20.8%, P = 0.002), and perception of lower peer support at work (2.6% vs. 22.9%, P < 0.001). In addition, female physicians more frequently suffered sexual harassment from male peers/colleagues (10% vs. 34%, P < 0.001), male health-care workers (7% vs. 26%, P = 0.001), or patients/caregivers independently from their sex (6% vs. 38.5%, P < 0.001 for males and 5% vs. 22%, P = 0.001 for females).

CONCLUSIONS

A significant number of the female vascular surgeons in Italian academic vascular centers responding to the survey have experienced workplace inequality and sexual harassment. Substantial efforts and ongoing initiatives are still required to address gender disparities, emphasizing the need for the promotion of specific guidelines within scientific societies.

In-State Retention Rates of Female Neurosurgery Graduates

OBJECTIVE

We sought to determine the rate of retaining female neurosurgery graduates in the same states as their medical education and identify medical school and state characteristics associated with high retention rates.

METHODS

Database from the Centers for Medicare & Medicaid Services was used to extract female physicians indicating "neurosurgery" as their specialty. The top 25 medical schools with the highest number of female neurosurgery graduates were selected. Descriptive analysis was used to determine the retention rate of female neurosurgery graduates. Univariable and multivariable analyses were used to identify medical school and state characteristics associated with high retention rates.

RESULTS

Medical schools with the highest retention rate included the University of California, San Francisco (60%), the University of Alabama (60%), and the University of Pennsylvania (60%). Univariable and multivariable analysis showed the number of female neurosurgery attendings (β = 0.036, 95% confidence interval [CI] = 0.003 to 0.070, P = 0.04 and β = 0.036, CI = 0.001 to 0.071, P = 0.04.) and the healthcare employment rate (β = 0.098, CI = 0.011 to 0.186, P = 0.03 and β = 0.117, CI = 0.021 to 0.212, P = 0.02) to be positively associated with the retention rate of female neurosurgery graduates.

CONCLUSIONS

Retaining female neurosurgery graduates within a state is essential for addressing the physician shortage and gender inequality. To encourage female medical students to practice in the same state, medical schools and states should work collectively to improve the visibility of female neurosurgeons and increase employment opportunities.

Gender and Mentorship in Military Medicine: A Survey Study

INTRODUCTION

Mentorship is essential for professional development and advancement within the military. In civilian medicine, the intersection between gender and mentorship holds important implications for research opportunities, academic success, and career progression. However, the intersection of gender and mentorship has not yet been explored within the field of military medicine. The purpose of this study, therefore, was to investigate the role of gender in mentorship within the field of military medicine.

MATERIALS AND METHODS

We investigated gender and mentorship within military medicine by developing and distributing a 16-item Likert survey to active-duty military physicians. We used the Chi-squared test of independence and the independent samples t-test to examine the role of gender in mentorship among the 16 questions.

RESULTS

The male respondents reported more same-gender mentors than females (male [M]: 61.9% vs. female [F]: 33.0%), whereas the female respondents had significantly more mentors of the opposite gender than males (M: 12.4% vs. F: 47.3%). A higher proportion of males indicated no preference compared to females. Conversely, a significant preference for a same-sex mentor was expressed by female respondents compared to male respondents (M: 5.2% vs. F: 30.1%). In contrast, female respondents considered having a mentor more important than their male counterparts (t(206) = -2.26, P = .012, F: 3.86 vs. M: 3.57). Both male and female respondents had significantly more female mentees ($\chi _{\left( 1 \right)}^2$ = 12.92, P < .001, Cramer's V = 0.254).

CONCLUSIONS

While the female participants in our study preferred female mentors, the male participants had more same-gender mentors than the female participants. In addition, more females reported that they did not have the time to be mentored. Our results, therefore, suggest that training males to be better mentors to females and providing accessible mentorship training to females may promote equitable career development within military medicine.

Trend of female first authorship in Journal of Orthopaedic Science, the official journal of the Japanese orthopaedic association from 2001 to 2021: An observational study

BACKGROUND

Women are underrepresented in orthopaedic surgery, especially in Japan. Authorship is associated with representation and career advancement, but the academic representation of women in Japanese orthopaedic surgery has not been elucidated. This study aimed to elucidate the proportion of female first authorship and its associating factors, as well as trends in the Journal of Orthopaedic Science (JOS), the official journal of the Japanese Orthopaedic Association.

METHODS

The study reviewed original articles published in JOS from 2002 to 2021 using data from PubMed on March 16, 2022. The gender of the first and last authors was determined using genderize. io, an online gender detection tool and manual search. The study used multivariable logistic regression to identify the factors associated with female first authorship and visualized the trend of predicted probability using restricted cubic spline curve.

RESULTS

Among 2272 original articles, 148 (6.5%) and 79 (3.5%) had female first and last authors, respectively. Compared with 2002-2006, female first authorship significantly increased in 2012-2016 (adjusted odds ratio [aOR], 2.04; 95% confidence interval [CI], 1.09-4.05; p = 0.03) and 2017-2021 (aOR, 2.72; 95% CI, 1.46-5.276; p = 0.002). Affiliation with an institution in Japan (aOR, 0.51; 95% CI, 0.35-0.74; p < 0.001) and affiliation in orthopaedics (aOR, 0.16; 95% CI, 0.11-0.23; p < 0.001) were negatively associated with female first authorship. Around 2020, the trend showed a gradual then rapid increase in women with non-orthopaedic affiliations. Only a very small increase was observed in women with an orthopaedic affiliation.

CONCLUSIONS

Female first authorship in JOS has been increasing. However, the proportion of female authors remains low. Authors outside of Japan and not affiliated with orthopaedics largely affect female authorship statistics. The results indicate the persistent gender gap in the academic representation of women in Japanese orthopaedic publications.

Descriptive Analysis of Vitreoretinal Surgery Fellowship Program Directors

Purpose: To evaluate the demographic, educational, and scholarly characteristics of Association of University Professors of Ophthalmology-accredited vitreoretinal surgery fellowship program directors in the United States and Canada. Methods: Demographic, educational, and scholarly profiles of identified program directors were collated from online public resources. Characteristics were compared by sex, program size, ranking, and affiliation. Results: Eighty-one program directors (mean age [±SD] 54.7 ± 11.0 years) from 78 fellowship programs were identified. The minority were women (14.8%), who were on average 6 years younger than their male counterparts (P = .07). The majority of program directors had an academic affiliation (90.1%), most commonly professor (54.8%). The mean h-index, 5-year h-index, and m-quotient were 20.9 ± 14.9, 5.9 ± 4.4, and 0.82 ± 0.42, respectively. Compared with their counterparts, program directors of both "top 10" and large programs published more manuscripts (P < .05), accrued more citations (P < .05), and had a higher h-index (P < .05). Fellowship programs with female program directors had a significantly larger proportion of female retina faculty (P = .002). Conclusions: The backgrounds of vitreoretinal surgery program directors are diverse. However, women remain underrepresented in this position, highlighting an area with the potential for greater equity in ophthalmology.

Representation of Women Authorship in the Top 5 Transplantation Journals in the United States

BACKGROUND

In the United States, only 13% of transplant surgeons are women. We evaluated gender distribution and trends of American authorship over the past 10 y in high-impact solid organ transplantation journals to gain insight into the current status of women authorship in transplantation.

METHODS

Original articles from 2012 to 2021 from the 5 highest-impact solid organ transplantation journals were extracted from Scopus. First and last author's gender was predicted using Genderize.io. Data of first and last authors, article type and topic, location, citation, and funding metrics were analyzed. Chi-square, logistic regression, and trend tests were performed where appropriate. Statistical significance was set at <0.05.

RESULTS

Women's first and last authorship increased over time among all journals. There was an increase in women first authors in the American Journal of Transplantation and in senior women authors in Liver Transplantation and Transplantation . Significant differences in gender authorship in lung, intestine, pancreas, general, and islet cell transplantation were found. Women's last authorship was associated with 1.69 higher odds of having a woman first author when adjusting for year and journal. There was an increase in the rate of women's first and last author collaborations over the years. Women last authors had 1.5 higher odds of being funded by the National Institutes of Health over the years.

CONCLUSIONS

Despite an increase in women transplant surgeons and physicians, the gap in women authorship in transplantation persists. Women's last authorship was associated with higher odds of having a woman first author, pointing to the importance of mentorship for women joining the transplant academia.

Investing in the Future: A Premedical Surgical Elective for Undergraduate Students

BACKGROUND

Research has shown that providing surgical exposure and mentorship before clerkship can bolster interest and cultivate quality surgical residents. However, most studies have focused exclusively on programs for 1st and 2nd year medical students. The purpose of this study is to describe a novel undergraduate premedical surgical elective (PMSE) and the interests and perceptions of PMSE participants of the surgical field.

METHODS

Undergraduate students applied for a semester long PMSE that included surgical shadowing, mentorship, a research component, attendance at seminars, and hands-on workshops. Post-PMSE completion, participants were invited to complete an online survey about their perceptions of pursuing a career in surgery and their specialties of interest.

RESULTS

Thirty-six PMSE participants completed the survey (21 females and 15 males). More than half (57%) of female respondents expressed interest in a surgical career. Most respondents (78%) agreed or strongly agreed that they are confident in their ability to become a surgeon. A lower proportion of female respondents (33%) believed the atmosphere of the surgical field to be inclusive than males (53%). Males accumulated significantly more surgical shadowing hours than females (P < .05).

DISCUSSION

Findings from this study describe a novel PMSE at a large undergraduate institution. Survey data of PMSE participants revealed a high proportion of female respondents would like to pursue a career in surgery and reported confidence in achieving this. However, females perceived the field to be less inclusive than male respondents. Improving inclusivity may require increased focus and attention by PMSEs and surgical education programs.

Beyond Parity: Gender Diversity of National and International Pediatric Surgery Societal Leadership

PURPOSE

Despite trends toward equal gender representation among medical school graduates, surgical trainees and fellows, diversity in higher levels of pediatric surgery is largely unstudied. This study aims to quantify gender diversity among leadership of pediatric surgical associations and societies across the globe.

METHODS

National and international pediatric surgical organizations were identified from the websites of the American Pediatric Surgical Association (APSA) and World Federation of Associations of Pediatric Surgery (WOFAPS). Compositional gender data of current and past organizational leadership was collected by examining publicly available archives of executive membership rosters. If roster pictures were not available, member names were input into social media sites and other search engines to ensure accurate gender denotation. Univariate analyses of organizational metrics and aggregate data of 5-year time intervals were performed via Fischer's Exact Test with significance of p < 0.05.

RESULTS

Nineteen pediatric surgical organizations were included for study analysis. Of 189 current organizational leaders, 50 (26.4%) are women. Eight organizations (42.1%) have less than 20% of leadership positions filled by women members, while two executive boards have no women members. Four organizations (22.2%) have a current woman seated as president/chairperson. Historical gender distribution stratified by organization demonstrates a range of 0-7.8% (p = 0.99), with one organization having yet to elect a woman president/chairperson. Longitudinally, women presidential representation remained consistently low (5-11%) across all time intervals from 1993 to 2022 (p = 0.35).

CONCLUSIONS

Despite advances in diversity in medical school graduates, surgical training, and workforce recruitment, there are still significant disparities in gender representation within pediatric surgery societal leadership.

LEVEL OF EVIDENCE

IV.

Pipeline to Military Orthopaedic Leadership: 20 Years of Race and Gender Diversity Trends Within Military Orthopaedic Surgery Fellowship Training

Background

The lack of trainees from underrepresented race and gender backgrounds in orthopaedic surgery fellowship training has been well reported in the literature. The purpose of this study was to investigate the demographic trends of federally sponsored military orthopaedic surgery fellows in the Army, Navy, and Air Force. We hypothesize that there has been an increase in women selected for fellowship but that there has been no change in the race demographics of military fellows over the past 2 decades.

Methods

A retrospective review of all available demographic data collected by the Army, Air Force, and Navy since the beginning of tracking federally funded fellowship training in orthopaedic surgery was completed (1998-2021). Data were grouped into 4-year periods for analysis to closely mirror the military assignment cycle.

Results

Three hundred sixty-two military orthopaedic surgery fellowship board selectees were included in our analysis. The proportion of women fellows increased from 3% (n = 2/69) over 2001 to 2004 to 21% (n = 17/82) during 2017 to 2020 (p < 0.05). Fellows who identified as White comprised 82% (n = 297) of the cohort during the study period. Individuals who identified as Asian were the next highest proportion of fellows at 4% (n = 16), followed by Black (n = 14, 4%) and Hispanic (n = 13, 3%). Individuals who identified as Native Hawaiian/Pacific Islander represented 1% (n = 3), and an additional 6% (n = 20) fellows identified as "other" or "undeclared." Over the 20-year study period, representation of Asian, Black, Native Hawaiian, and Hispanic fellows did not increase (p = 0.79, 0.81, 0.45, 0.34, respectively).

Conclusions

Within military orthopaedics, there has been increased representation of women in fellowship training over the past 20 years. However, the proportion of fellows from underrepresented racial and ethnic groups has remained stagnant. One barrier to improving gender and race representation is the currently imprecise and inconsistent collection of demographic information. Importantly, fellowship training has a direct effect on future leadership opportunities within the military orthopaedic surgery community. A more diverse leadership may help to inspire future generations of military orthopaedic surgeons.

Level of Evidence

IV.

Demographic and practice patterns among minimally invasive surgery fellowship graduates

INTRODUCTION

Previous reports show that over 85% of general surgery residents choose to pursue fellowship training after completing residency. There continues to be an increase interest among general surgery residents in minimally invasive surgery (MIS) fellowship. Moreover, demographic disparities, particularly gender disparities continue to persist among surgical sub-specialties. In this study, we evaluated the gender disparities and practice patterns among graduating MIS fellows.

METHODS AND PROCEDURES

MIS fellows were surveyed, and 169 results were received from fellows who completed training in the years: 2010, 2015-2019. Surveys collected were used to create a descriptive analysis of the demographics, practice patterns and job finding measures. Loglinear regression model was performed to assess gender trend variation over training years.

RESULTS

Fellows self-reported gender showed 65% male, 30% female, and 5% prefer not to say. The cohort of participants was described as 45.3% white, 5.3% African American, and 6.5% Hispanic or Latino. Further, results showed 87.1% of fellows work in MIS surgery with 91.8% reporting their fellowship experience facilitated their ability to find a job. Most alumni pursue a comprehensive MIS practice. Moreover, the proportion of female fellows increased from 29 to 41%, but this increase over time was not significant using loglinear regressions [p-value = 0.0810, Relative risk = 1.1994 (95% CI 0.9778, 1.4711)].

CONCLUSION

Overall, there is good evidence to support that fellowship training facilitates future career advancements. Further, MIS fellows have differential practice patterns. Finally, females remain underrepresented among the MIS fellows which should call for leadership action to bridge these gaps.

The Role of Gender-Concordant Mentorship in Women Premedical Students' Perception and Pursuit of Surgical Careers

OBJECTIVE

Evaluate the impact of a 6-month structured mentorship program between women premedical student mentees paired with women medical students and surgical residents on mentees' interests and perceptions of surgical careers.

DESIGN

Prospective qualitative and quantitative study.

SETTING

This study took place at the Boston University School of Medicine, a single institution tertiary care hospital.

PARTICIPANTS

Self-identified women premedical students at Boston University were eligible for inclusion in this program (n=90). Participants were recruited and grouped with self-identified women medical student (n=52) and resident (n=19) mentors. Participants were provided with a monthly curriculum to guide discussions. Mentees completed pre- and postprogram surveys with 5-point Likert scale questions regarding interest and exposure to surgery, role models and mentorship, and effect of COVID-19 on their career interests. Pre- and postprogram responses were compared using a Wilcoxon rank sum test.

RESULTS

Of the 90 mentees, 63 (70%) completed preprogram surveys, and 53 (59%) completed postprogram surveys. Survey respondents indicated statistically significant increased exposure to positive role models (preprogram mean 3.15, postprogram mean 4.06, p=0.0003), increased exposure to women role models (preprogram 2.30, postprogram 3.79, p<0.0001), increased access to dedicated mentors (preprogram 2.11, postprogram 3.75, p<0.0001), and increased availability of support persons to answer their questions and concerns about careers in surgery (preprogram 3.03, postprogram 3.85, p=0.001). There was also a statistically significant increase in the reported effect that exposure to gender-concordant role models in surgery had on participants' decisions to consider a surgical career (preprogram 3.58, postprogram 4.23, p=0.001).

CONCLUSION

This 6-month structured mentorship program for undergraduate premedical students increased mentees' exposure to positive women role models and mentors, and increased mentee's interest in pursuing a surgical career. This emphasizes the need for structured gender-concordant mentorship programs early in women's careers to encourage pursuit of surgical careers in an otherwise men-dominated field.

Gender Diversity in Urology Residency Program Leadership Is Associated With Gender Diversity in Residency Cohort

OBJECTIVE

To evaluate the association of program director (PD) gender on the proportion of female residents in urology residency programs.

METHODS

Demographics for program faculty and current residents matched in the 2017-2022 cycles at United States' accredited urology residency programs were collected from institutional websites. Data verification was completed using the American Urological Association's (AUA) list of accredited programs and the programs' official social media channels. Proportion of female residents across cohorts was compared using two-tailed Student's t-tests.

RESULTS

One hundred forty-three accredited programs were studied, and 6 were excluded for lack of data. Thirty (22%) of the 137 programs studied have female PDs. Of 1799 residents, 571 (32%) are women. There has been an upward trend in the proportion of females matched from 26% in 2018 to 30% in 2019, 33% in 2020, 32% in 2021, to 38% in 2022. When compared to programs with male PDs, those with female PDs had a significantly higher proportion of female residents (36.2% vs 28.8%, p = .02).

CONCLUSION

Nearly one-quarter of urology residency PDs are female, and approximately one-third of current urology residents are women, a proportion that has been increasing. Programs with female PDs are more likely to match female residents, whether those programs with female leadership rank female applicants more favorably or female applicants rank those programs higher. Given the ongoing gender disparities in urology, these findings indicate notable benefit in supporting female urologists in academic leadership positions.

Trends in Racial, Ethnic, and Gender Diversity Among Hand Surgery Fellows From 2007 to 2021

PURPOSE

There is a paucity of research on the demographic trends of orthopedic and plastic hand surgery fellows. The purpose of this study was to ascertain the current state of racial and gender demographic trends in hand surgery fellowship from 2007 to 2021.

METHODS

We analyzed fellowship demographic data from the Accreditation Council for Graduate Medical Education public database from 2007-2008 through 2020-2021. The gender of hand surgery fellows was categorized as male, female, or not reported and their race/ethnicity as White, Non-Hispanic; Asian or Pacific Islander, Hispanic; Black, Non-Hispanic; American Indian or Alaskan Native; other; or unknown. We extracted the number of fellows per year for each category and calculated the percentage equivalents and average percentages. We performed the chi-square test for trend (Cochran-Armitage test) to identify any significant changes in the percentages of gender and race/ethnicity between 2007 and 2021.

RESULTS

There was a significant increase in the percentage of hand surgery fellows who are women (20.7% to 30.7%) and Asian or Pacific Islander (13.3% to 25.3%). There was no significant change in the percentage of Hispanic or Black, Non-Hispanic fellows.

CONCLUSIONS

Although there have been some increases, hand surgery fellows continue to be underrepresented by women and minorities, consistent with the demographic of orthopedic and plastic surgery residents. There have been increasing trends in the number of women and minorities in medical schools, which leaves room for improvement from the downstream prospective applicant pool.

CLINICAL RELEVANCE

The physician-patient relationship can potentially be strengthened by race and gender concordance; however, many minority and female hand surgery patients do not have physicians who are women or of the same ethnic background. Patient satisfaction, trust, and potential health outcomes may be improved with a physician workforce that reflects the diversity of their patients.

Gender Disparity in Earliest Phase of Academic Surgical Training: An Area for Intervention

BACKGROUND

To overcome persistent gender disparities in academic surgery, it is critical to examine the earliest phase of surgical training. This national study sought to assess whether gender disparities also existed among surgical interns, as a proxy for medical school research experience in both quantity and quality.

STUDY DESIGN

Using the 2021 to 2022 public information of 1,493 US-graduated categorical general surgery interns, a bibliometric evaluation was conducted to assess medical school research experience. Multivariable linear regressions with response log-transformed were performed to evaluate the impact of intern gender on (1) total number of peer-reviewed publications, (2) total impact factor (TIF), and (3) adjusted TIF based on authorship placement (aTIF). Back-transformed estimates were presented.

RESULTS

Of these interns, 52.3% were female. Significant differences were observed in TIF (male 6.4 vs female 5.3, p = 0.029), aTIF (male 10.8 vs female 8.7, p = 0.035), gender concordance with senior authors (male 79.9% vs female 34.1%, p < 0.001), Hirsch index (male 21.0 vs female 18.0, p = 0.026), and the geographic region of their medical schools (p = 0.036). Multivariable linear regressions revealed that female interns were associated with lower TIF (0.858, p = 0.033) and aTIF (0.851, p = 0.044). Due to a significant gender-by-region interaction, adjusted pairwise comparisons showed that male interns in the Northeast had approximately 70% higher TIF (1.708, p = 0.003) and aTIF (1.697, p = 0.013) than female interns in the South.

CONCLUSIONS

Gender disparities existed in the quality of research experience in the earliest phase of surgical training. These timely results call for additional interventions by the stakeholders of graduate medical education.

Projected timeline to achieve gender balance within the United States neurosurgical workforce exceeds 150 years: a National Plan and Provider Enumeration System analysis

OBJECTIVE

Despite incremental progress in the representation and proportion of women in the field of neurosurgery, female neurosurgeons still represent an overwhelming minority of the current US physician workforce. Prior research has predicted the timeline by which the proportion of female neurosurgery residents may reach that of males, but none have used the contemporary data involving the entire US neurosurgical workforce.

METHODS

The authors performed a retrospective analysis of the National Plan and Provider Enumeration System (NPPES) registry of all US neurosurgeons to determine changes in the proportions of women in neurosurgery across states, census divisions, and census regions between 2010 and 2020. A univariate linear regression was performed to assess historical growth, and then Holt-Winter forecasting was used to predict in what future year gender parity may be reached in this field.

RESULTS

A majority of states, divisions, and regions have increased the proportion of female neurosurgeons from 2010. Given current growth rates, the authors found that female neurosurgeons will not reach the proportion of women in the overall medical workforce until 2177 (95% CI 2169-2186). Furthermore, they found that women in neurosurgery will not match their current proportion of the overall US population until 2267 (95% CI 2256-2279).

CONCLUSIONS

Whereas many studies have focused on the overall increase of women in neurosurgery in the last decade, this one is the first to compare this growth in the context of the overall female physician workforce and the female US population. The results suggest a longer timeline for gender parity in neurosurgery than previous studies have suggested and should further catalyze the targeted recruitment of women into the field, an overhaul of current policies in place to support and develop the careers of women in neurosurgery, and increased self-reflection and behavioral change from the entire neurosurgery community.

Diversity, Equity, and Inclusion on Editorial Boards of Global Health Journals

Journals have been described as “duty bearers” of upholding fundamental ethical principles that are essential for maintaining the ethical integrity of newly generated and disseminated knowledge. To play our part, we evaluated diversity and inclusion in the leadership and management of global and international health journals. We developed Journal Diversity Index (JDI) to measure three parameters of diversity and representation (gender, geographic, socioeconomic status). Relevant information regarding editorial board members of systematically screened journals was sequentially extracted and job titles were categorized into five editorial roles. Chi-squared test was utilized to study associations between gender and geographic distribution of editors along with the Medline indexing of the journal and its impact factor. Out of 43 journals included, 62.7% were published from two high-income countries. Women comprised 44% of the total editors. Among all the editorial board members, we did not find any information suggesting the representation of non-binary and transgender individuals. Furthermore, 68.2% of editors were based in high-income countries with 67.3% of the editors belonging to the Global North. This disparity in geographic region and socioeconomic level was observed across all five editorial roles. Among all women editors, more than 70% worked in non-Medline and non-impact factor journals. Only two journals scored “excellent” on JDI. Despite the continuous evolution of the definition of global health ethics, marginalized individuals, and their perspectives remain underrepresented in this field. Thus, we call for swift action regarding the decentralization and redistribution of global and international health journal editorial boards.

Path to Parity: Trends in Female Representation Among Physicians, Trainees, and Applicants in Urology and Surgical Specialties

OBJECTIVE

To characterize recent trends among practicing female surgeons, surgical trainees, and surgical residency applicants to assess potential progress toward gender parity.

METHODS

Workforce statistics on U.S. practicing surgeons, trainees, and applicants among 9 surgical specialties were obtained from the Association of American Medical Colleges and Electronic Residency Application Service public databases. Physician and trainee data during 2007-2019 and residency applicant data during 2016-2020 were analyzed by surgical specialty. We used Cochrane Armitage trend tests to assess changes over time.

RESULTS

Female practicing urologists increased 104% during the study period, the third-largest increase among 9 surgical specialties (range 36%-114%, all P < .01), representing continued growth in the prevalence and proportion of women among surgical trainees in all surgical disciplines. In contrast, the overall change for female urology residents (28%) lagged significantly, ranking eighth among the 9 specialties (range 9%-149%, all P < .01), suggesting slowing growth in the training pipeline. Finally, while the proportional change in urology applicants has been significant (33%, P < .01), growth rates have markedly slowed in the past 5 years compared to women in practice and training since 2007.

CONCLUSION

While female representation among practicing urologists has improved relative to other surgical disciplines, declining rates of women entering and applying to urology residency suggest a longer trajectory toward gender parity.

Motivators and deterrents for early career female doctors applying to surgical training programmes in the UK National Health Service: a mixed-methods study

OBJECTIVES

To perform a mixed-methods study identifying motivators and deterrents to female doctors interested in core surgical training (CST). To provide tangible implementations based on the findings.

DESIGN

This study used quantitative (questionnaires) and qualitative (semistructured interviews (SSIs)) analyses. Participants completed online questionnaires on Qualtrics and SSIs were conducted remotely on Microsoft Teams. Questions were derived from previous studies and a novel term, the gender impact rating (GIR), was coined to assess the impact of gender on opportunities available during CST application.

SETTING

Participants were working in the UK National Health Service and data collected from December 2020 to January 2021.

PARTICIPANTS

A total of 100 female surgical trainees in the UK ranging from Foundation Year 2 to Core Training Year 2.

MAIN OUTCOME MEASURES

Participants ranked factors by their influence on their CST application. Of the 100 trainees, 21 were randomly selected for an SSI to explore their questionnaire responses. Statistical analyses were performed using MATLAB and SPSS, alongside a thematic analysis of the interviews.

RESULTS

A total of 44 out of 100 questionnaire respondents ranked early exposure to surgery as the most influential motivator, while 43% selected work-life balance as the greatest deterrent and 33% suggested mentoring schemes to encourage women to apply to CST. The median GIR was 3 out of 5, indicating a moderate perceived impact of gender on opportunities available during CST application. Qualitative analysis found four overarching themes: institutional factors (including mentorship schemes), organisational culture (including active engagement), social factors and personal factors.

CONCLUSION

Thematic analysis suggested that seniors involving women in theatre and a supportive work environment would encourage entry of more female surgeons. Therefore, the proposed implementations are the active engagement of women in theatre and destigmatising less than full-time training. Further research into ethnicity and personality on motivations to enter surgery is advised.

The Impact of Same Gender Speed-Mentoring on Women's Perceptions of a Career in Surgery - A Prospective Cohort Study

BACKGROUND

Mentoring is critically important for the personal and professional development of a surgeon. Early career stage mentoring by same-gender role models may help ameliorate the gender imbalance in surgery based on our understanding of barriers for women pursuing surgical careers. A novel method of establishing these relationships is speed mentoring. This study aims to examine the impact of a one-day speed-mentoring session with same gender mentors on a cohort's perceptions of a career in surgery.

DESIGN

This prospective pre-post study compared attitudes and perceptions of a career in surgery before and after a speed-mentoring session with female surgeons. Mentees were assigned into groups of 1 or 2 and were paired with a female surgeon for 8 minutes. Each mentee group then rotated to another mentor for the same amount of time and this process continued for a total of twelve sessions. Mentees completed a 19-point questionnaire before and after the speed mentoring intervention.

SETTING

This multicenter study included participants from across the United Kingdom.

PARTICIPANTS

Inclusion criteria were female gender and medical student or foundation year doctor (internship year 1 or 2) status. Three hundred and forty participants participated in the intervention, 191 were included in the analysis.

RESULTS

Following intervention, the percentage of participants who agreed that having a family would negatively impact a woman's surgical career progression significantly decreased from 46.6% to 23.0%. The percentage of participants who agreed that an "old boys' club" attitude exists in surgery also significantly decreased (73.8%-58.1%). The percentage of participants who agreed it was more difficult for a woman to succeed in her surgical career than a man significantly decreased (73.8%-64.9%). One hundred and eighty-three (96%) participants agreed that mentorship is important for career progression and 153 (71.2%) participants stated that they did not have someone who they considered a mentor.

CONCLUSIONS

Conducting a speed mentoring program with same-gender role models significantly changed female medical students' and junior doctors' perceptions of women in surgery. The results suggest that such programs may be effective tools for facilitating mentor-mentee relationships and could be employed by surgical organizations to encourage a diverse uptake into surgery.

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

Background

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

Objective

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

Design

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

Results

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

Conclusions

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

Early Barriers to Career Progression of Women in Surgery and Solutions to Improve Them: A Systematic Scoping Review

OBJECTIVE

This study aims to summarize the evidence concerning the barriers that exist to the career progression of women in surgery and to provide potential solutions to overcome these obstacles.

BACKGROUND

Visible and invisible impediments can hinder female doctors' pursuit of a surgical career, from choosing a surgical specialty to training opportunities and all the way through career progression.

METHODS

Database search of original studies about barriers for female surgeons during choice of surgical career, residency, and career progression. A query including possible solutions such as mentorship and network was included.

RESULTS

Of 4618 total articles; 4497 were excluded as duplicates, having incorrect study focus, or not being original studies; leaving 120 studies meeting the inclusion criteria. Of the articles included, 22 (18%) focused on factors affecting the pursuit of a surgical career, such as surgical work hours and limited time for outside interests, 55 (46%) analyzed the main barriers that exist during surgical residency and fellowship training, such as discrimination and sexual harassment, 27 (23%) focused on barriers to career advancement, heavy workloads, ineffective mentorship, unclear expectations for advancement, inequality in pay or work-home conflicts. Among studies reporting on possible solutions, 8 (6.5%) articles reported on the role of effective mentorship to support career advancement and to provide moral support and 8 (6.5%) on the emerging role of social media for networking. Our analysis showed how different impediments hinder surgical career progression for women, with notable consequences on burnout and attrition.

CONCLUSIONS

Identification and recognition of obstacles to career progression is the first step to addressing the gender gap in surgery. Active strategies should be improved to promote a culture of diversity and to create equal opportunity for women in surgery, while implementing structured mentoring programs and investing on an adequate communication on social media to engage the future generations.

Implementation of a Structured Surgery Mentorship Program and Success in the Surgical Residency Match

INTRODUCTION

General Surgery residency programs remain competitive, with over a quarter of US MD seniors failing to match into a categorical program each year. While previous literature has shown the role of mentorship in attracting medical students to surgery, there is a dearth of information demonstrating the role of mentorship in successfully matching those students to surgery programs.

METHODS

We implemented a structured mentorship program for medical students interested in applying to general surgery or integrated plastics, vascular, or cardiothoracic residencies over the course of one year, consisting of seven standardized meetings and events spanning the students' MS3 and MS4 years. Following Match Day, we sent students a five-point Likert scale survey to assess the perceived utility of each event and solicited self-reported application information.

RESULTS

Of the 22 students at a single institution who attended the structured mentorship program and applied to general surgery residency, 100% matched into a categorical program, significantly higher than the 73% national match rate of US MD seniors into general surgery (P < 0.01). There were no significant differences between the two cohorts in terms of United States Medical Licensing Examination board scores, Alpha Omega Alpha Honor Society status, or median number of publications, research experiences, work experiences, or volunteer experiences. Nineteen of the 22 students responded to the survey, yielding an 86% response rate. Ninety percent of the students attended at least six out of the seven events. Six out of the seven events had median helpfulness scores (out of five) that were significantly higher than a "neutral" baseline (P < 0.05).

CONCLUSIONS

A structured mentorship program may play a useful role in successfully matching general surgery applicants to residencies and would be a simple and low-cost program to implement at other medical schools.

Have Factors Influencing Female Medical Students' Intention to Pursue a Career in Surgery Changed over the Last 10 Years? A Systematic Review

In 2012, a systematic review reported on factors influencing female medical students, career intentions for surgery. This current review is a direct follow-up of that article with the aim of assessing whether factors affecting female medical student career choices have changed over the last decade. This review has identified access to research opportunities as a new factor that can be used to promote female medical student and trainee interest in surgery. Other factors have largely remained unchanged over the last 10 years, such as lack of access to leave, part-time work, and same-gender role models.

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

Background

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

Methods

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

Results

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

Conclusion

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

Pragmatic Mentoring Strategies for the Busy Surgeon Scientist

OBJECTIVE

The value of research mentorship in academic medicine is well-recognized, yet there is little practical advice for how to develop and sustain effective mentoring partnerships. Gaining research skill and mentorship is particularly critical to success in academic surgery, yet surgeon scientists are challenged in their mentorship efforts by time constraints and lack of education on how to mentor. To address this gap, this study explored the strategies that award-winning faculty mentors utilize in collaborating with their medical student mentees in research.

DESIGN, SETTING, AND PARTICIPANTS

For this qualitative study, the authors invited physician recipients of an institution-wide mentorship award to participate in individual, semi-structured interviews during July and August 2018. Following interview transcription, the authors independently coded the text and collaboratively identified common mentoring strategies and practices via a process of thematic analysis.

RESULTS

Nine physician mentors, representing a mix of genders, medical specialties and types of research (basic science, clinical, translational, and health services), participated in interviews. The authors identified 12 strategies and practices from the interview transcripts that fell into 5 categories: Initiating the partnership; Determining the research focus; Providing project oversight; Developing mentee research competence; and Supporting mentee self-efficacy.

CONCLUSION

Award-winning mentors employ a number of shared strategies when mentoring medical trainees in research. These strategies can serve as a guide for academic surgeons who wish to improve their research mentoring skills.

Gender Differences in Perceptions and Attitudes of Medical Students Towards Neurosurgery: A German Nationwide Survey

BACKGROUND

Despite advances in gender equity, the paucity of women neurosurgeons remains. In Germany, women accounted for only 24% of the specialists who completed their neurosurgical training in 2019. We sought to explore the perceptions of medical students in Germany towards a neurosurgical career, focusing on gender-specific differences.

METHODS

A digital 26-item questionnaire with a Likert 4-point scale and open-ended questions was distributed to the German Medical School student bodies. Data was analyzed to determine statistically significant intra-group variability between women and men.

RESULTS

210 medical students participated in the survey. Women and men were equally interested in brain pathologies (38% vs. 47%, strongly agreed), whereas interest in neurosurgery was significantly greater in men (12% vs. 26%, strongly agreed). Men were less likely to believe that women neurosurgery residents would face inequality at work. They were also less likely to support a gender quota in neurosurgery. Yet, both women and men were convinced that a rise in the number of women would positively impact the field. No gender-dependency was seen in students' strive for success and prestige. Men felt discouraged from pursuing neurosurgery because they feared an unpleasant work environment whereas women were concerned about neurosurgery not being family-friendly. Regardless of gender, the greatest factor deterring students from neurosurgery was poor work-life balance.

CONCLUSION

Awareness must be raised concerning gender inequity and discrimination in our specialty. A multifaceted approach is imperative to develop neurosurgery into a profession where gender no longer hinders access to training and success in the field.

Discrimination Towards Women in Surgery: A Systematic Scoping Review

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.

Career barriers for women in surgery

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.

Moving the Needle: Directed Intervention by the American Society for Surgery of the Hand Is Effective in Encouraging Diversity in Expert Panel Composition

Purpose

Recent efforts have been made by the American Society for Surgery of the Hand to encourage female inclusion in expert panels. We hypothesized that female representation on expert panels has increased over the past decade and that a directed intervention by the American Society for Surgery of the Hand would be associated with an increased percentage of submissions with female panelists.

Methods

We performed a retrospective analysis of Instructional Course Lecture and Symposium submissions for the 2011 through 2021 American Society for Surgery of the Hand Annual Meetings. Authorship was reviewed, and the gender of the proposed authors was recorded. Additionally, the status of “all-male panel” was attributed to panels with no proposed female authors. Submissions were reviewed and compared with meeting programs to determine the status of accepted or rejected. Longitudinal analysis was performed to determine trends in the gender composition of expert panels.

Results

In total, 1,687 submissions were reviewed, including 1,323 Instructional Course Lectures and 364 Symposia. Female authorship constituted 18% of authorship (1,170/6,663), and lead authorship was similarly distributed, with 18% being female (296/1,687). Overall, female representation has increased steadily over the past decade, with females constituting 13% (43/332) and 20% (163/818) of the submitted authors in 2011 and 2020, respectively. Similarly, all-male panels declined from 74% (76/103) to 46% (85/185) of panels over the same timeframe. Most strikingly, a sharp increase in gender representation was observed with the directed intervention noted in the 2021 Call for Abstracts, resulting in an increase in female authorship to 26% (295/1,124) and a decline in all-male panels to 29% (70/241).

Conclusions

Gender representation among hand surgery expert panels moved toward increased equity over the past decade, which has been aided by directed interventions.

Clinical relevance

Career development and trainee decision making are impacted by gender representation; directed and intentional interventions by professional organizations are effective in encouraging greater equity and diversity within the field.

Medical Student Career Choice: Who Is the Influencer?

BACKGROUND

While many factors influence medical student career choice, interactions with attending and resident physicians during clinical rotations are particularly important. To evaluate the influence of attending and resident physicians on medical students' career choices, particularly for those pursuing surgical careers, we quantified their respective influence in the context of other known influences.

METHODS

Rising fourth-year medical students and new graduates were given an IRB-exempt, 14-item online survey. Descriptive statistics were performed on the demographic information. Chi-square analysis was used, as were Kruskal-Wallis and Mann-Whitney analyses on the Likert responses (α = 0.05).

RESULTS

Survey response was 24%. Students pursuing general surgery rated residents greater than or equal to attendings on 7 of 8 key mentoring characteristics. Of students choosing a different specialty than the one they intended to pursue upon entering medical school, the influence of residents was cited by 100% of the students pursuing general surgery, compared to 59% of the entire cohort. Identification of a role model and perceived personality fit were significantly more important than other factors (P < 0.0001). Students pursuing general surgery rated the importance of identifying a role model and perceived personality fit greater than their peers.

CONCLUSIONS

Residents have greater influences on medical students' career choice compared to attendings. Students pursuing a surgical specialty, particularly general surgery, considered the influence of role models and perceived personality fit to be the most important factors in their specialty decision. These findings provide valuable insights to improve student experiences and career recruitment in surgical specialties, particularly general surgery.

60 Years After the First Woman Cardiac Surgeon: We Still Need More Women in Cardiac Surgery

In 1960, Dr Nina Starr Braunwald became the first woman to perform open heart surgery. Sixty years later, despite the fact that women outnumbered men in American medical school in 2017, men still dominate the field of cardiac surgery. Women surgeons remain underrepresented in cardiac surgery; 11% of practicing cardiac surgeons in Canada were women in 2015, and 6% of practicing adult cardiac surgeons in the US were women in 2019. Although women remain a minority in other surgical specialties also, cardiothoracic surgery remains one of the most unevenly–gender distributed specialties. Why are there so few women cardiac surgeons, and why does it matter? Evidence is emerging regarding the benefits of diversity for a variety of industries, including healthcare. In order to attract and retain the best talent, we must make the cardiac surgery environment more diverse, equitable, and inclusive. Some causes of perpetuation of the gender gap have been documented in the literature—these include uneven compensation and career advancement opportunities, outdated views on family dynamics, and disproportionate scrutiny of women surgeons, causing additional workplace frictions for women. Diversity is an organizational strength, and gender-diverse institutions are more likely to outperform their non-gender-diverse counterparts. Modifiable issues perpetuate the gender gap, and mentorship is key in helping attract, develop, and retain the best and brightest within cardiac surgery. Facilitating mentorship opportunities is key to reducing barriers and bridging the gap.

Traits of the current traditional pathway cardiothoracic surgery training pool: Results of a cross-sectional study

OBJECTIVE

As new paradigms for cardiothoracic surgery training emerged in recent years, the traditional 2- or 3-year pathway has persisted as an option for trainees completing general surgery residencies. Although the applicant pool for 6-year integrated cardiothoracic surgery training programs has been superficially explored, little data exist characterizing those applicants to the traditional cardiothoracic surgery training pathway and the influence of 6-year integrated expansion on the traditional applicant pool.

METHODS

We reviewed materials from candidates applying to a single 2-year cardiothoracic surgery training program between 2015 and 2020. Descriptive and comparative analyses of multiple characteristics were performed over the years of the study.

RESULTS

During the years 2015 through 2020, we received 571 applications, accounting for 72% of the total National Residency Matching Program applicant pool. We saw no significant trends in numbers of peer-reviewed publications or presentations. There was a minimal year-to-year increase in number of first-authored posters, 2.04 in 2015 to 2.13 in 2020 (P = .008). Online publications, book chapters, and other publications were stable throughout the study period. Applicants consistently provided an average of 3.6 letters of recommendation, 1.9 from cardiothoracic surgery faculty. Mean in-service score percentiles were stable at the 54th percentile, whereas US Medical Licensing Examination scores increased.

CONCLUSIONS

Despite expansion of the 6-year integrated pathway to cardiothoracic surgery, we have seen no substantial year-to-year changes in attributes of traditional applicants. Our findings suggest that the cardiothoracic surgery applicant pool continues to be composed of a stable group of highly productive trainees. Future initiatives in candidate selection should emphasize interview strategies to highlight aspects of grit, emotional intelligence, and team dynamics.

Association of Demographic Factors and Medical School Experiences With Students' Intention to Pursue a Surgical Specialty and Practice in Underserved Areas

Importance

The surgical workforce shortage is a threat to promoting health equity in medically underserved areas. Although the Health Resources and Services Administration and the American College of Surgeons have called to increase the surgical pipeline for trainees to mitigate this shortage, the demographic factors associated with students' intention to practice in underserved areas is unknown.

Objective

To evaluate the association between students' demographics and medical school experiences with intention to pursue surgery and practice in underserved areas.

Design, Setting, and Participants

This cross-sectional study surveyed graduating US allopathic medical students who matriculated between 2007-2008 and 2011-2012. Analysis began June 2020 and ended December 2020.

Main Outcomes and Measures

Intention to pursue surgery and practice in underserved areas were retrieved from the Association of American Medical Colleges graduation questionnaire. Logistic regression models were constructed to evaluate (1) the association between demographic factors and medical students' intention to pursue surgical specialties vs medical specialties and (2) the association between demographic factors and medical school electives with intention to practice in underserved areas.

Results

Among 57 307 students who completed the graduation questionnaire, 48 096 (83.9%) had complete demographic data and were included in the study cohort. The mean (SD) age at matriculation was 23.4 (2.5) years. Compared with students who reported intent to pursue nonsurgical careers, a lower proportion of students who reported intent to pursue a surgical specialty identified as female (3264 [32.4%] vs 19 731 [51.9%]; χ2 P < .001). Multiracial Black and White students (adjusted odds ratio [aOR], 1.72; 95% CI, 1.11-2.65) were more likely to report an intent for surgery compared with White students. Among students who reported an intention to pursue surgery, Black/African American students (aOR, 3.24; 95% CI, 2.49-4.22), Hispanic students (aOR, 2.00; 95% CI, 1.61-2.47), multiracial Black and White students (aOR, 2.27; 95% CI, 1.03-5.01), and Indian/Pakistani students (aOR, 1.31; 95% CI, 1.02-1.69) were more likely than White students to report an intent to practice in underserved areas. Students who reported participating in community health (aOR, 1.61; 95% CI, 1.42-1.83) or global health (aOR, 1.83; 95% CI, 1.61-2.07) experiences were more likely to report an intention to practice in underserved areas.

Conclusions and Relevance

This study suggests that diversifying the surgical training pipeline and incorporating health disparity and community health in undergraduate or graduate medical education may promote students' motivation to practice in underserved areas.

Characterization of Cardiothoracic Surgeons Actively Leading Basic Science Research

BACKGROUND

There is increasing concern regarding the attrition of surgeon-scientists in cardiothoracic (CT) surgery. However, the characteristics of CT surgeons who are actively leading basic science research (BSR) have not been examined. We hypothesized that early exposure to BSR during training and active grant funding are important factors that facilitate the pursuit of BSR among practicing CT surgeons.

MATERIALS AND METHODS

We created a database of 992 CT surgeons listed as faculty at accredited United States CT surgery teaching hospitals in 2018. Data regarding each surgeon's training/professional history, publication record, and National Institutes of Health funding were acquired from publicly available online sources. Surgeons who published at least one first- or last-author paper in 2017-2018 were considered to be active, lead researchers.

RESULTS

Of the 992 CT surgeons, 73 (7.4%) were actively leading BSR, and 599 (60.4%) were actively leading only non-BSR. Only 2 women were actively leading BSR. Surgeons actively leading BSR were more likely to have earned a PhD degree (20.5% versus 9.7%, P = 0.0049), and more likely to have published a first-author BSR paper during training (76.7% versus 40.9%, P< 0.0001). Surgeons actively leading BSR were also more likely to have an active National Institutes of Health grant (34.2% versus 5.8%, P< 0.0001), especially an R01 grant (21.9% versus 2.5%, P< 0.0001).

CONCLUSIONS

A small minority of CT surgeons at academic training hospitals are actively leading BSR. In order to facilitate the development of surgeon-scientists, additional support must be given to trainees and junior faculty, especially women, to enable early engagement in BSR.

Women in Leadership and Their Influence on the Gender Diversity of Academic Plastic Surgery Programs

BACKGROUND

Women seldom reach the highest leadership positions in academic plastic surgery. Contributing factors include lack of female role models/mentors and lack of gender diversity. Studies show that female role models and mentors are critical for recruiting and retaining female surgeons and that gender diversity within organizations more strongly influences women's career choices. The authors therefore sought to determine the current gender diversity of academic plastic surgery programs and investigate influences of gender and leadership on program gender composition.

METHODS

A cross-sectional study of U.S. plastic surgery residency programs was performed in December of 2018. Genders of the leadership were collected, including medical school dean, department of surgery chair, department/division of plastic surgery chair/chief, plastic surgery program director, plastic surgery faculty, and plastic surgery residents. Gender relationships among these groups were analyzed.

RESULTS

Ninety-nine residency programs were identified (79 integrated with or without independent and 20 independent). Women represented a smaller proportion of academic plastic surgeons in more senior positions (38 percent residents, 20 percent faculty, 13 percent program directors, and 8 percent chairs). Plastic surgery chair gender was significantly correlated with program director gender, and plastic surgery faculty gender was significantly associated with plastic surgery resident gender. Although not statistically significant, female plastic surgery chair gender was associated with a 45 percent relative increase in female plastic surgery residents.

CONCLUSIONS

Women in leadership and gender diversity influence the composition of academic plastic surgery programs. Gender disparity exists at all levels, worsening up the academic ladder. Recruitment, retention, and promotion of women is critical, as such diversity is required for continued progress in innovation and problem-solving within plastic surgery.

Gender Trends of Authors Presenting at a Regional Vascular Surgery Meeting

OBJECTIVE

We hypothesized a potential gender disparity within a regional society like the Southern Association of Vascular Surgery (SAVS) when compared to vascular surgery demographics in the region. To assess this, we analyzed meeting and membership participation at SAVS compared to regional data from the Society of Vascular Surgery (SVS) as well as Board certification in Vascular Surgery published by the American Board of Surgery (ABS).

METHODS

The published programs from the SAVS Annual Meeting from 2012 to 2019 were analyzed for membership, presenter gender, type, topic, discussant gender, moderator gender, post graduate course presenter gender, as well as manuscript publication demographics. The ABS was petitioned and yearly Vascular Surgery diplomate (ABS-VS) gender from member states of the SAVS was examined for the same period. Fisher's Exact students t-test and Analysis of Covariance were utilized.

RESULTS

There were 257 total presentations (184 podium, 71.6%; 73 poster, 28.4%). 61.4% (n=43) of presentations by females were podium presentations, compared to 75.4% (n=141) for males (p=0.03). Females were less likely to be published when compared to their male counterparts (41.8% vs. 58.7%, p=0.02). Percentage of female gendered presenters statistically increased over the time period examined compared to a decrease in male presenters (R² = 0.61, m=1.27 vs. R² = 0.08, m=-0.35, p=0.02). Females presenters had a female discussant 10.5% of the time compared to male presenters who had a male discussant 95.1% of the time (p<0.0001). Females comprised 3.8 ± 1.1% of SAVS yearly membership compared to 12.0 ± 4.6% ABS-VS diplomates among SAVS member states (p<0.0001). SAVS female membership significantly lagged behind the increase in ABS-VS female diplomate rate (p=0.001). Only 39.1% of SAVS members were cross listed in SVS membership rolls, with a total of 464 potential SAVS members, 11.2% or 52 of which are female.

CONCLUSIONS

We found that female presenters at the SAVS annual meeting were less likely to be podium presenters, interface with other female discussants and publish manuscripts when compared to their male counterparts. Statistically, female members were underrepresented within the SAVS membership rolls when compared to known boarded female vascular surgeons among southern member states. This gender gap highlights a unique opportunity to enhance and potentially increase mentorship opportunities for female trainees who are presenting and/or attending this regional vascular surgery meeting.

A Global Perspective of Mentorship in Medical Schools: Systematic Review from 2014 to 2019

Formal mentorship programs afford medical students research involvement, career guidance, and personal and professional development. We reviewed a total of 36 studies on mentorship in medical schools, 17 of which are from the United States (US) and 19 from outside the US. This descriptive study has determined the most common mentorship models used in medical schools both in the United States and internationally. Despite variance between programs, medical students in the US and worldwide prefer highly invested mentors with strong interpersonal skills. We concluded that both US and international mentorship provide crucial professional development for students; however, US-based mentorship is more focused on providing experience within individual specialties. More studies on current mentorship practices in medical schools are required to ensure that the diverse international medical education community is better represented.

Comparison of Performance Score for Female and Male Residents in General Surgery Doing Supervised Real-Life Laparoscopic Appendectomy: Is There a Norse Shield-Maiden Effect?

BACKGROUND

Gender bias may represent a threat to resident assessment during surgical training, and there have been concerns that women might be disadvantaged. There is a lack of studies investigating gender differences in 'entry-level' real-life procedures, such as laparoscopic appendectomy. We aimed to explore potential gender disparities in self-evaluation and faculty evaluation of a basic surgical procedure performed by junior surgical residents in general surgery.

METHODS

A structured training program in laparoscopic appendectomy was implemented before undertaking evaluation of real-life consecutive laparoscopic appendectomies by junior residents in general surgery. Resident and faculty gender-pairs were assessed. Intraclass correlation coefficient (ICC) was calculated using a single-rater, consistency, 2-way mixed-effects model.

RESULTS

A total of 165 paired sessions were completed to evaluate resident-faculty scores for the procedure. Overall, 19 residents participated (43% women) and 26 faculty (42% women) were involved. The overall correlation between faculty and residents was good (ICC > 0.8). The female-female pairs scored higher for most steps, achieving excellent (ICC ≥ 0.9) for several steps and for overall performance. Female residents were more likely to give a higher self-evaluated score on own performance particularly if evaluated by a female faculty. Also, female trainees had highest correlation-score with male faculty.

CONCLUSIONS

This study found higher performance scores in female surgical residents evaluated during real-time laparoscopic appendectomy. No negative gender bias toward women was demonstrated. Better insight into the dynamics of gender-based interaction and dynamics in both training, feedback and influence on evaluation during training is needed when evaluating surgical training programs.

Women in thoracic surgery: social media and the value of mentorship

Social media serves as a tool to fill gaps in current efforts to promote women in cardiothoracic surgery, and, given its global reach, may be a particularly effective modality. Social media has an important role in networking and mentorship, especially for women seeking careers in specialties with relatively sparse female representation, such as cardiothoracic surgery. In addition, social media may facilitate professional interactions, collaboration, growth of online reputations, engagement in continued education, communication of novel research findings, and patient education. Herein, we review the evidence for social media in the networking and mentorship of women in cardiothoracic surgery. Future studies are needed to establish the durability of social media efforts and predictors in its effectiveness in achieving its goals.