Progress in neurosurgery: Contributions of women neurosurgeons in the Middle East

Saudi women pioneers in neurological surgery: Insights into progress and inclusion

Forty years ago, General Professor Dr. Khalaf Al-Mouteary established the first neurosurgical department in the Kingdom of Saudi Arabia. Here, we explored various pieces of evidence on the progress and inclusion of Saudi female pioneers in the neurosurgical workforce of the Kingdom of Saudi Arabia. We gathered information data on the inclusion of women in neurological surgery retrieved from open-resource online documentation of the Ministry of Health and direct communication with Saudi Commission for Health Specialties (SCFHS) administrative services. Furthermore, regional neurosurgery program directors, four active registered consultants, were either interviewed live or through offline communications. Data on the current number of board-certified, active female neurosurgeons in either the government or private sectors, along with the number of current neurosurgery postgraduate residency program trainees, were obtained from the registered database of the SCFHS. Since 2002, 18 women (29 %) have graduated from the Saudi Neurosurgical Residency Training Program (SNRTP), in contrast,71 % of the graduates were male. The SNRTP is now training more than 34 females (30 %), who are progressing in their neurosurgical training across the country. The first Saudi woman to pursue neurosurgery was Dr Samia Abdel-Rahim Maimani, while the first woman to pass the Saudi Neurosurgery Board was Dr Aisha Al-Hajjaj in 2002. In 2021, board-certified female neurosurgeons in Saudi Arabia will represent approximately 3 % of all practicing neurosurgeons.

Neurosurgery in Saudi Arabia: Navigating Through Future Pathways and Students' Perspectives

BACKGROUND

Neurosurgery is a surgical discipline that demands comprehensive knowledge in other specialties. It is regarded as one of the most competitive specialties. However, there is a new trend toward considering life-style friendly specialties. Therefore, this study aims to assess the neurosurgery perception and identify potential factors influencing such attitudes.

METHODS

An observational, survey-based study was conducted on medical students at the College of Medicine, Imam Abdulrahman bin Faisal University, Dammam, Saudi Arabia. An online-based questionnaire was administered to the participants. It consisted of 2 main parts: the first part collected demographic data, while the second part included 20 Likert scale-based questions. Pearson's χ2 test was utilized, with statistical significance set at P < 0.05.

RESULTS

A total of 305 medical students from various academic years participated in the questionnaire survey, with nearly an equal gender distribution. Remarkably, a significant majority (76.72%) expressed uncertainty or disagreement regarding the adequacy of neurosurgery education during their medical studies. While a substantial portion of participants (69.5%) found neurosurgery intriguing, almost half (47.87%) indicated that they would not pursue it as their future specialty. The consideration of neurosurgery as a career path showed statistically significant differences in relation to both gender and academic year (P = 0.009 and P < 0.001, respectively).

CONCLUSIONS

This study emphasizes how gender and academic year affect choosing neurosurgery as a career but notes limitations like self-reporting bias and a single-institution scope, which may affect generalizability. Future research might consider national summer training programs to engage more students in neurosurgery.

Canadian Women in Neurosurgery: From Early Pioneers to World Leaders

BACKGROUND

Since the emergence of neurosurgery as a distinct specialty ∼100 years ago in Canada, it took >40 years for Canadian women to enter the field in the province of Quebec, and longer in the other provinces.

METHODS

We provide a historical overview of Canadian women in neurosurgery, from the early pioneers to the modern-day leaders and innovators in the field. We also define the current participation of women in Canadian neurosurgery. Chain-referral sampling, historical books, interviews, personal communications, and online resources were used as data sources.

RESULTS

Our historical review highlights the exceptional journey and unique experiences of female neurosurgeons, describes their achievements, and identifies career obstacles and enabling factors. We also incorporate comments from Canadian female neurosurgeons, both retired and in active practice, addressing gender inequities in the field, and provide advice and encouragement to the new generations to come. Despite the achievements of these female trailblazers, women represent a small proportion of the Canadian neurosurgery trainees and the active workforce, in stark contrast to the increasing number of women in medical school.

CONCLUSIONS

To the best of our knowledge, this study represents the first historical overview of female women neurosurgeons in Canada. Providing a historical context will help us to better understand the important role of women in modern neurosurgery, identify persistent gender issues in the field, and provide a vision for aspiring female neurosurgeons.

Equity in neurosurgery: a worldwide survey of women neurosurgeons

OBJECTIVE

The global neurosurgery workforce does not have a defined stance on gender equity. The authors sought to study and characterize the demographic features of the international women neurosurgery community and to better understand the perceptions and reflections of their neurosurgical careers. The objective was to define and characterize the workplace inequities faced by the global women neurosurgeon community.

METHODS

A 58-item cross-sectional survey was distributed to the global women neurosurgery community. The survey was distributed via an online and mobile platform between October 2018 and December 2020. Responses were anonymized. The authors utilized chi-square analysis to differentiate variables (e.g., career satisfaction) between various groups (e.g., those based on academic position). The authors calculated 95% CIs to establish significance.

RESULTS

Among 237 respondents, approximately 40% were between the ages of 26 and 35 years. Within their respective departments, 45% identified themselves as the only woman neurosurgeon in their practice. Forty-three percent stated that their department supported women neurosurgeons for leadership roles. Seventy-five percent of respondents were members of organized neurosurgery professional societies; of these, 38% had been involved in leadership roles. Almost 60% of respondents postponed their decision to get pregnant because of resident or work-related influences.

CONCLUSIONS

This survey provides international feedback for characterizing and understanding the experiences of women neurosurgeons worldwide. Future research should aim to understand all neurosurgeons' experiences throughout the pipeline and career life cycle of neurosurgery in order to improve the field of neurosurgery.

Status of Women in Neurosurgery: Results from a National Survey in Italy

Background

Gender inequity in surgery has increasingly been a matter of debate. Contributions of female neurosurgeons to academic medicine and societies are poorly highlighted. The aim of this study was to evaluate several aspects of the professional and work-life balance of female neurosurgeons in Italy.

Methods

Data of the female neurosurgical population were extracted from a general 83-item questionnaire administered to a total of 3242 respondents. The survey was composed of multiple-choice questions investigating demographics, surgical training and practice, satisfaction, mentorship, discrimination, and harassment.

Results

A total of 98 female neurosurgeons were included. Most responders were married or cohabiting (49%). Thirty-nine (43%) were planning to have children, and 15 of them (44%) stated the reason they still didn't have any was because of professional constraints. Seventy (71%) women were neurosurgeons with an academic position (residents or academics) and 28 (29%) were full-time attendings. Most of the female neurosurgeons are satisfied with their work: sometimes (35%), often (20%), and always or almost always (20%). Most of them (45%) stated they are rarely victims of harassment, but 66% think that they are treated differently because they are women. A similar rate for a poor and fulfilling work-life balance (34% and 35%, respectively) was detected. The majority of participants (89%) had encountered a role model during their career, but in only 11% of cases was that person female.

Conclusions

Even though the rate of satisfaction among female neurosurgeons in Italy is high, some of them experienced gender discrimination, including incidents of sexual harassment and microaggressions. Policies including job sharing paradigms, consistent and meaningful options for parental leave, mentorship programs, equal and fair remuneration for equal work, and zero tolerance for harassment should be encouraged.

Perceptions of Neurosurgery among Medical Students and Interns: A National Cross-Sectional Study

Background: Neurosurgery is considered one of the most admired surgical specializations. Still, as evidenced by observations over the years, it is not amongst the top choices of medical students in Saudi Arabia. This study will help in understanding the perception and attitudes of medical students and interns toward the neurosurgery specialization, which will aid in developing strategies to increase the interest of undergraduates in neurosurgery specialization and bridge the human resource gap in this vital specialty. Objectives: This study aimed to assess perceptions, attitudes, and gender differences of medical students and interns toward neurosurgery. The influence of demographic factors on perceptions of neurosurgery of interns and senior medical students in Saudi Arabia was also investigated. Methodology: We conducted a cross-sectional study on a convenience sample of medical students (clinical years) and interns studying in different colleges of medicine in Saudi Arabia. A total of 1014 responses were included in this study (518 males and 496 females). The questionnaire comprised of two parts: the first part carried general descriptive questions, while the second part had 24-item Likert scale-based questions. Results: Around 40% of medical students and 26% of interns agreed or strongly agreed to the statement ‘I would consider a career in neurosurgery. Around 70% of both interns and students agreed or strongly agreed with the statement ‘Huge prestige is attached to neurosurgery’. The responses to the statement ‘Neurosurgery is a male specialty’ was significantly different between genders, as 36.5% of the male respondents agreed or strongly agreed with the statement while just 12.5% of the females responded likewise (p = 0.000). Only 23% of participants reported having completed a rotation in neurosurgery. About 44.7% of respondents were interested in taking an elective rotation in neurosurgery, while the remaining respondents (55.3%) responded with a negative answer. Only 23% of participants had completed an undergraduate rotation in neurosurgery. More males (65.3%) agreed or strongly agreed with the statement ‘Work as a neurosurgery specialist can impede family life as compared to females (57.5%), which was highly significant (p = 0.000). More medical students (45.1%) responded in the agreement or strong agreement in response to the statement’ Neurosurgery should be a compulsory rotation during internship’ as compared to interns (25.8%). Around 65% of the respondents agreed or strongly agreed that teachers/seniors have a great influence on students’ specialization choices. Around 67% of the respondents foresaw a purely clinical role for themselves after graduation, while 17% were interested in a clinical–academician role. Conclusions: The study reflected a generally positive attitude towards neurosurgery amongst medical students and interns. Interest in neurosurgery as a specialization can be strengthened by enhancing the exposure of students and interns to the specialty. Teachers and seniors can be useful influencers to motivate students to consider neurosurgery specialization.

Gender disparity in neurosurgery: A multinational survey on gender-related career satisfaction

Introduction

Women continue to be underrepresented in the majority of surgical specialties, including neurosurgery.

Research question

In this multinational survey, we aimed to assess current gender disparities in neurosurgery focusing on job satisfaction and inequity/discrimination at work.

Material and methods

Female and male members of the European Association of Neurosurgical Societies were asked to complete an electronic survey (Google Forms, Mountain View) containing demographic baseline data and questions on attitudes regarding gender disparity, personal experience with gender inequity and career satisfaction/work-life balance. Quantitative analyses were performed to analyse the responses, including summary and comparative statistics.

Results

We received 168 responses from 40 different countries. Survey responders had a mean age of 40.8 ​± ​11.5 years; 29.8% were female. There were significant more male than female residents and attending surgeons per department. Eighty-eight percent of female and 38.1% of male responders experienced gender inequity or discrimination at work (adjusted OR 10.8, 95%CI 4.2–27.8, p<0.001). Female neurosurgeons were more likely to be discriminated by colleagues (aOR 4.32, 95%CI 2.1–9.1, p<0.001) and by patients/relatives (aOR 3.65, 95%CI 1.77–7.54, p<0.001). There was a trend towards lower job satisfaction (p=0.012), less satisfaction with career goals (p=0.035) and worse work-life balance (p=0.0021) in female surgeons.

Discussion and conclusion

This survey underlines that a significant proportion of neurosurgeons – in particular females – continue to experience gender inequity & discrimination at work, which may translate into lower work-related satisfaction. A better understanding of the gender-related aspects of job satisfaction is an important step to improving gender equity in our profession.

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Women continue to be underrepresented in clinical and academic neurosurgery.

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The most common source of discrimination are patients/relatives and colleagues.

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Women generally report lower job satisfaction in neurosurgery.

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Progress towards gender equity has been made in the last decade.

International Women in Neurosurgery

The history of women in neurosurgery worldwide has been characterized by adversity and hardships in a male-dominated field, where resilient, tenacious, and ingenious women have nevertheless left their mark. The first women in neurosurgery appeared in Europe at the end of the 1920s, and since then have emerged in all continents in the world. Women neurosurgeons all over the globe have advanced the field in numerous directions, introducing neurosurgical subspecialties to their countries, making scientific and technical advances, and dedicating themselves to humanitarian causes, to name a few. The past 30 years, in particular, have been a period of increasing involvement and responsibility for women in neurosurgery. We must now focus on continual system improvements that will promote a diverse and talented workforce, building a welcoming environment for all aspiring neurosurgeons, in order to advance the specialty in the service of neurosurgical patients.