Factors Influencing Female Medical Students' Decision to Pursue Surgical Specialties: A Systematic Review

Seeing is Believing - A Qualitative Study Exploring What Motivates Medical Students to Pursue a Career In General Surgery

OBJECTIVE

The personal statement (PS) is a rich text in which medical students introduce themselves to the programs to which they are applying. There is no prompt or agreed upon structure for the personal statement. Therefore it represents a window in to medical students' beliefs and perceptions. The goal of this study was to identify what events or experiences motivate medial students to pursue a career in general surgery. Previous work in this area has been largely survey and interview-based. This study is unique in that it looks at what medical students say when not prompted.

DESIGN

This is a single-institution, retrospective, qualitative review of applicants' PSs. The PSs were coded based on an a priori coding scheme. The coding scheme was based on published literature of why medical students might apply for a general surgery training position.

SETTING

Academic, safety-net hospital.

PARTICIPANTS

The study evaluated a subset of the PSs of applications submitted through the Electronic Residency Application Service (ERAS) for a categorical general surgery position in our program during the 2022 match. Specifically, 308 of all received applications were included in this study. This is the subgroup of applications that was pulled out for a close review based on holistic screening of received applications.

RESULTS

The single most frequently mentioned motivating factor for applying to general surgery training was the experience a student had on the surgery clerkship. The early years of medical school and sub-internships were less frequently identified as motivating experiences. After the overall clerkship experience, the next most frequent motivating factors were that their personality fit well with the culture of surgery and that they realized the important role surgeons played in patient care. 59 applicants wrote about a pre-existing interest in surgery prior to entering medical school. Most frequently this interest developed after witnessing family or friends or applicant themselves have surgery or shadowing a surgeon.

CONCLUSIONS

In this study, students most frequently noted the clerkship experience as having sparked their interest in a career in surgery. Having had exposure to surgeons, through personal experience or shadowing, often led to students to develop an interest in pursuing a career in surgery prior to entering medical school. The findings suggest that to increase the attractiveness of surgery to potential applicants, positive exposure to surgeons and surgery as a field of practice are critical.

Medical Student Perceptions of Family Planning During Residency Training in Surgical Fields

INTRODUCTION

Several studies have investigated surgical residents' perceptions of family planning, and many have investigated medical students' perceptions of surgical specialties; however, there is limited research on medical students' perceptions of the impact of family planning on the decision to pursue surgical training. This study aims to investigate male and female medical students' perceptions of family planning in residency.

METHODS

A survey was distributed to all medical students at a single medical school in the Midwest between February 2023 and June 2023. The survey was adapted from a prior study investigating resident perceptions of family planning. It included questions about parental leave, having children, and perceived barriers to family planning.

RESULTS

One hundred students completed surveys. Seventy-four (74%) respondents identified as female and 57 (57%) were interested in surgery. Approximately half (55, 55%) of the respondents were strongly or definitely considering having children during residency. However, only eight (8%) students were aware of policies applicable to having children during residency. A majority (85, 85%) felt the decision to pursue surgical residency would prevent or delay having children at their preferred time. Most students felt they would be negatively perceived by peers (62, 62%) and faculty (87, 87%) if they had children during training. The highest perceived barriers to having children during training were work-time demands, childcare barriers, and time away from training.

CONCLUSIONS

Both men and women are interested in having children during residency but are unaware of the relevant parental leave policies and are concerned about how training will be impacted by taking time away or a lack of flexibility. Without transparency and flexibility in surgical residency, both men and women may forgo having children during training or choose a specialty they perceive to be more conducive to childbearing.

Enhancing Our Workforce: Recruitment and Retention in Anesthesiology

Increasingly, both healthcare leaders and studies of healthcare outcomes recommend a medical workforce that is representative of the patient population as a method to reduce health disparities and medical costs. Anesthesiology remains a specialty with lower proportions of women and underrepresented in medicine (URiM) physicians as compared to the overall physician workforce, with 26.1% of anesthesiologists identifying as women and 31.3% of anesthesiologists as URiM. Two areas of focus are commonly identified when discussing inadequate representation in the workforce: recruitment into the specialty and retention in the profession. As medical educators, we provide a critical role in the recruitment and retention of women and URiM anesthesiologists, through implementation of processes, programs, and cultural change. Here, we will discuss the current problems of recruitment and retention of women and URiM anesthesiologists and suggest action plans for now and the future to enhance our specialty's diversity.

Concerns, Perceptions, and Career Considerations of Female Medical Students Interested in Neurosurgery: A Qualitative Case Study

BACKGROUND

Neurosurgery exhibits notably lower representation of Black, Hispanic, and female surgeons compared to various other medical and surgical specialties. Existing research focuses on medical students' views on surgeons, factors influencing female medical students' preferences in surgical fields, and the perceived interests and concerns of students contemplating a career in neurosurgery. However, there is a significant gap in understanding the unique concerns and perspectives of female medical students interested in neurosurgery.

METHODS

Semistructured interviews with female medical students were recruited from medical schools in the District of Columbia area. Interview questions were based on Lent and Brown's Social Cognitive Career Theory. Transcripts were analyzed thematically into codes.

RESULTS

In total, 8 female medical students from our institution participated. We identified 3 major themes that influenced medical students decision-making: sense of belonging (diversity, mentorship, and passionate), self-efficacy (ambitious/"gunner," intense/competitive), and outcome expectations (innovation/research, immediate impact, procedural/surgical aspect, salary, and work-life balance).

CONCLUSIONS

Female medical students face distinct challenges and factors to consider when choosing a career in neurological surgery. The biggest concern for female students was a sense of belonging. It is imperative to enhance the diversity within the neurosurgical specialty and boost the representation of female neurosurgeons. Early interventions designed to tackle and alleviate their specific concerns are pivotal in achieving this goal.

Exploring Factors Influencing Medical Trainees' Specialty Choice: Insights from a Nationwide Cross-Sectional Survey in Jordan

Phenomenon: Choosing a medical specialty is a critical decision that significantly impacts medical students' future career. Understanding the factors influencing this decision-making process is important for medical educators, policymakers, and healthcare providers to develop effective strategies that support and guide students in making informed decisions. Approach: We distributed an online self-administered questionnaire to clinical-year medical students (Years 4 to 6) and interns from all medical faculties in Jordan. The questionnaire gathered demographic information, specialty preferences, and factors influencing specialty decision-making. We analyzed the data using descriptive statistics and logistic regression. Findings: 1805 participants completed the questionnaire (51.7% women). General surgery was the most preferred specialty among both genders, followed by internal medicine. Women significantly preferred family medicine, pediatrics, obstetrics and gynecology, and dermatology, whereas men significantly preferred urology, orthopedic surgery, neurosurgery, general surgery, and internal medicine. The factors that most strongly influenced respondents' specialty preferences were the specialty's perceived stress levels and working hours, whereas the least influential factors were the specialty's perceived prestige and role models in the specialty. Women's specialty preferences were significantly more influenced by their family than men's. Men were substantially more influenced by specialties' perceived action-orientation and stress levels than women. Insights: Gender significantly influences medical trainees' specialty preferences in Jordan. Women tended to prefer specialties that provided greater work-life balance, such as family medicine, pediatrics, obstetrics and gynecology, and dermatology, while men were more drawn toward competitive and profitable surgical specialties like orthopedic surgery, neurosurgery, urology, and general surgery. Additionally, family had a stronger influence on women's decisions, likely due to cultural and social expectations prioritizing marriage and family for women. Career counseling and mentorship programs are needed to provide guidance, support, and networking opportunities that can help women overcome barriers and biases that may hinder their career advancement.

Academic Neurosurgery in Nigeria- Past, Present, and Future: A Review

Nigeria's neurosurgical field faces profound challenges, including a critically low neurosurgeon-to-patient ratio and significant migration of medical professionals to developed countries. High costs, low socioeconomic status, and the urban-centric location of neurosurgical centers impede access to care. Key barriers to service delivery include lack of manpower, insufficient emergency care, limited imaging modalities, inadequate operative equipment, and ineffective political and administrative policies. Neurotrauma is the primary reason for neurosurgical intervention but is poorly managed due to delayed access and insufficient guidelines. The neurosurgical education system is strained by limited training capacity and the absence of subspecializations, restricting specialized care. Research output is low, hindered by limited infrastructure, lack of databases, insufficient funding, and minimal international collaboration. To address these issues, it is critical to enhance the imaging capabilities, ensure the availability of operative equipment, and establish effective policies for task sharing and communication at different levels of care. Other approaches include expanding training capacity, particularly in rural areas, implementing a uniform match system for residency, addressing gender disparities, and utilizing dual practice to ensure adequate compensation for neurosurgeons. Furthermore, stakeholders should develop subspecialization programs in areas such as neurovascular, neuro-oncology, pediatric neurosurgery, and minimally invasive neurosurgery to expand service scope. To transform the neurosurgical research landscape, efforts should be made to establish electronic medical databases, foster international collaborations to ensure funding, and make research mandatory for accreditation renewal to ensure continuous academic contribution.

Pregnancy and infertility in orthopedics: A review of the current state

BACKGROUND

Orthopedic surgery continues to have one of the lowest rates of female trainees among all medical specialties in the United States. Barriers to pursuing a surgical residency include the challenges of family planning and work-life balance during training.

METHODS

A systematic literature search of articles published between June 2012 and December 2022 in the MEDLINE, EMBASE, and Cochrane databases was performed in January 2023 according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis). Studies were included if they evaluated pregnancy and peripartum experience and/or outcomes amongst orthopedic surgeons or trainees.

RESULTS

Eighteen studies were included. Up to 67.3% of female orthopedic surgeons and trainees and 38.7% of their male counterparts delayed childbearing during residency. The most reported reasons for this delay included career choice as an orthopedic surgeon, residency training, and reputational concerns among faculty or co-residents. Infertility ranged from 17.0% to 30.4% in female orthopedic surgeons and up to 31.2% suffered obstetric complications. Assisted Reproductive Technology (ART) resulted in 12.4%-56.3% of successful pregnancies. Maternity and paternity leaves ranged from 1 to 11 weeks for trainees with more negative attitudes associated with maternal leave.

CONCLUSIONS

Female orthopedic trainees and attending delay childbearing, experience higher rates of obstetric complications, and more stigma associated with pregnancy compared to their male colleagues. Program and institutional policies regarding maternity and paternity leave are variable across programs, and therefore, attention should be directed toward standardizing policies.

Gender trends in match rate to surgical specialties in Canada: A retrospective study from 2003-2022

BACKGROUND

In Canada, there is a recognized underrepresentation of women in the field of surgery. However, the extent to which this trend applies across various surgical specialties is not well delineated. The aim of this study is to identify existing disparities and trends over time to inform the need for future interventions to make the match process more equitable for applicants.

METHODS

Data regarding surgical specialty applicants was extracted from the Canadian Resident Matching Service (CaRMS)'s 2003 to 2022 reports.

RESULTS

A total of 9,488 applicants ranked surgical specialties as their first choice from 2003-2022. Increases in the proportion of women applicants comparing periods 2003-2007 to 2018-2022 were significant for cardiac surgery (22% to 43%, p = 0.03), general surgery (46% to 60%, p<0.001), orthopedic surgery (23% to 35%, p<0.001), urology (23% to 38%, p<0.001), and all aggregated surgical specialties ('all surgery') (45% to 55%, p<0.001). An increase in the proportion of women applicants who matched over the same periods was observed for general surgery (+47% to 60%, p<0.001), orthopedic surgery (24% to 35%, p<0.01), urology (21% to 34%, p<0.001), and all surgery (46% to 54%, p<0.001). From 2003-2022, a lower match rate for women compared to men was observed for otolaryngology (0.60 v 0.69, p = 0.008), urology (0.61 v 0.72, p = 0.003), and all surgery (0.71 v 0.73, p = 0.038), while higher match rates were observed for ophthalmology (0.65 v 0.58, p = 0.04). No statistically significant differences in match rate were observed from 2018-2022.

CONCLUSIONS

While the proportion of women applicants to surgical specialties in Canada has been increasing, women remain underrepresented in several surgical specialties. This underrepresentation cannot be solely attributed to fewer women applying to these specialties, as women experience lower success rates when matching to specific surgical specialties. Further research is essential to identify and address the underlying causes of these disparities.

Implementation of a novel peer review academy by Surgery and the Association of Women Surgeons

BACKGROUND

A novel Peer Review Academy was developed as a collaborative effort between the Association of Women Surgeons and the journal Surgery to provide formal training in peer review. We aimed to describe the outcomes of this initiative using a mixed methods approach.

METHODS

We developed a year-long curriculum with monthly online didactic sessions. Women surgical trainee mentees were paired 1:1 with rotating women surgical faculty mentors for 3 formal peer review opportunities. We analyzed pre-course and post-course surveys to evaluate mentee perceptions of the academy and assessed changes in mentee review quality over time with blinded scoring of unedited reviews. Semi-structured interviews were conducted upon course completion.

RESULTS

Ten women surgical faculty mentors and 10 women surgical trainees from across the United States and Canada successfully completed the Peer Review Academy. There were improvements in the mentees' confidence for all domains of peer review evaluated, including overall confidence in peer review, study novelty, study design, analytic approach, and review formatting (all, P ≤ .02). The mean score of peer review quality increased over time (59.2 ± 10.8 vs 76.5 ± 9.4; P = .02). In semi-structured interviews, important elements were emphasized across the Innovation, Implementation Process, and Individuals Domains, including the values of (1) a comprehensive approach to formal peer review education; (2) mentoring relationships between women faculty and resident surgeons; and (3) increasing diversity in the scientific peer review process.

CONCLUSION

Our novel Peer Review Academy was feasible on a national scale, resulting in significant qualitative and quantitative improvements in women surgical trainee skillsets, and has the potential to grow and diversify the existing peer review pool.

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.

An overview of occupational injuries among female orthopaedic surgeons

Introduction

The aim of this study was to assess occupational injuries among female orthopaedic surgeons and compare these rates to their male counterparts.

Methods

An electronic survey was developed to assess occupational injuries among female orthopaedic surgeons. Descriptive statistics were analyzed for all survey items, and chi-squared tests and paired t-tests were used when appropriate.

Results

169 female orthopaedic surgeons completed this survey, the average age was 50 years old. MSK Injuries: Among the 169 responding surgeons, there were a total of 320 work-related musculoskeletal injuries. Non-MSK Occupational Injuries: Female orthopaedic surgeons experience social isolation at much higher rates than their male counterparts (53.8 % and 32.9 % respectively, p < 0.0001) as well as psychological distress since beginning practice (61.5 % and 55.3 % respectively). Additionally, female orthopaedic surgeons report higher rates of burnout (72.2 %, p = 0.01) compared to male orthopaedic surgeons (63.4 %). Female orthopaedic surgeons also sought out counseling from mental health professionals at higher rates than their male counterparts since beginning training (37.3 % and 28.6 % respectively, p = 0.02). 13.1 % of female respondents reported having been diagnosed with cancer since starting practice. Additionally, 94.6 % of female orthopaedic surgeons have experienced a finger stick and 16.1 % of female orthopaedic surgeons have experienced hearing loss since beginning practice.

Discussion

This study assesses the occupational injuries that affect female orthopaedic surgeons' physical and mental well-being. We found that in comparison to male orthopaedic surgeons, the major differences were found in the psychological and emotional domains. Women reported experiencing burnout and social isolation as well as seeking professional counseling at significantly higher rates than males; however, both genders reported concerningly high numbers. This could suggest that more resources need to be made available to help orthopaedic surgeons cope with the stresses of their demanding profession, with a specific emphasis on reducing work-related stress among female orthopaedic surgeons.

The impact of a novel surgical forum, 'Virtual Surgical Speed Dating', on career perception for medical students: a pilot study

BACKGROUND

The SARS-CoV-2 pandemic limited medical student's exposure to surgical specialities, potentially affecting their understanding of specialties and limiting access to mentorship.

AIMS

To develop a novel online 'round table' session to increase medical student's exposure to surgical careers, and to assess the value of the event as an educational tool.

METHOD

A virtual education session was held, with questionnaires being completed before and after the virtual event. The event began with an introduction to surgical training. Participants rotated every 10 min in groups, with two specialties represented by a specialist registrar at each station. Data were analysed using a 5-point Likert scale, and a Student Evaluation of Educational Quality (SEEQ) questionnaire was completed.

RESULTS

Of the 19 students involved, 14 (73.7%) were female, and 16 (84.2%) were undergraduate. The specialty attendees were most interested in before and after the event were neurosurgery (21.1%, n = 4) and cardiothoracic surgery (26.3%, n = 5), respectively. Five (26.3%) students changed the subspecialty they were most interested in after the event. Attendees' knowledge of surgical training in Ireland improved from 52.6% prior to the educational session to 69.5% after (p < 0.001). The session resulted in an increase in the perceived importance of research (4 [IQR 2-4] versus 4 [IQR 4-5], p = 0.0021).

CONCLUSIONS

This 'Virtual Surgical Speed Dating' event offered medical students an opportunity to interact with various surgical specialties despite the SARS-CoV-2 pandemic. The novel approach increased medical students' exposure to surgical trainees, improved knowledge of training pathways and altered student values influencing career decision-making.

Career satisfaction in women surgeons: A systematic review and meta-analysis

BACKGROUND

Career satisfaction among women surgeons have been well-reported in literature. This study provides a comprehensive review to understand career satisfaction and its contributory factors among female surgeons.

METHODS

PRISMA guidelines were utilized to extract studies for systematic review and meta-analysis. Outcomes assessed included surgical career satisfaction, career reconsideration, work-life balance, and gender bias and discrimination (GBD). Odds ratios were calculated comparing women to men for each outcome.

RESULTS

This study demonstrated that female surgeons were less likely to endorse overall career satisfaction (OR, 0.68; 95% CI, 0.55-0.85) and work-life balance satisfaction (OR, 0.61; 95% CI, 0.40-0.92) compared to male surgeons. It also revealed that women surgeons were more likely to report workplace GBD (OR, 13.82; 95% CI, 4.37-43.65).

CONCLUSIONS

Future interventions may be necessary to increase career and work-life balance satisfaction among women surgeons while reconciling the need to ensure they are adequately informed of the obligations of a surgical career.

Attitudes of Canadian medical students towards surgical training and perceived barriers to surgical careers: a multicentre survey

Background

Medical student interest in surgical specialties continues to decline. This study aims to characterize attitudes of Canadian medical students towards surgical training and perceived barriers to surgical careers.

Methods

An anonymous survey was custom designed and distributed to medical students at the University of Alberta and University of Calgary. Survey questions characterized student interest in surgical specialties, barriers to pursuing surgery, and influence of surgical education opportunities on career interest.

Results

Survey engagement was 26.7% in 2015 and 24.2% in 2021. General surgery had the highest rate of interest in both survey years (2015: 38.3%, 2021: 39.2%). The most frequently reported barrier was worry about the stress that surgical careers can put on personal relationships (2015: 70.9%, 2021: 73.8%, p= 0.50). Female respondents were significantly more likely to cite gender discrimination as a deterrent to surgical careers (F: 52.0%, M: 5.8%, p < 0.001).

Conclusions

Despite substantial interest, perception of work-life imbalance was the primary reported barrier to surgical careers. Further, female medical students' awareness of gender discrimination in surgery highlights the need for continued efforts to promote gender inclusivity within surgical disciplines to support early career women interested in surgery.

Women in surgery: trends in nine surgical specialties

BACKGROUND

Gender disparity in surgery remains an issue worldwide. We analysed the trends in gender distribution in surgical subspecialties across Australia and New Zealand over the last 8 years.

METHODS

Workforce reports from the Royal Australasian College of Surgeons were reviewed from 2014 to 2021. Data relating to 4802 applicants, 1554 trainees and 6839 active surgeons across nine surgical subspecialties was analysed. Statistical analysis was performed using a difference of proportions hypothesis test. Predictions regarding time to parity were performed using a linear regression model.

RESULTS

All nine surgical subspecialties' surgeon numbers saw a steady increase in the representation of women between 2014 and 2021. The most significant rise seen in general surgery from 14% to 21% (P ≤ 0.001). Proportions of women trainees were variable, the only significant rise was seen in orthopaedics from 9% to 19% (P ≤ 0.001). Proportions of women applicants and successful applicants have also been variable. General surgery saw the only consistent increase in women applicants over the last 6 years, from 35% in 2016 to 43% in 2021. Linear regression predictions estimate that paediatric surgery will be the first to reach gender parity in 23 years, and orthopaedics the last, in 186 years.

CONCLUSION

A steady increase in women has been observed across all surgical subspecialities over the last 8 years. However, estimates based on current trends suggest that gender parity may be out of reach for the next eight generations in subspecialties such as cardiothoracic and orthopaedic surgery.

Examination of residency program websites for the use of gendered language and imagery

BACKGROUND

Significant disparity in gender distribution exists among medical specialties. Residency program websites are a main source of preliminary program information for candidates, and website content may influence a prospective applicant's sense of belongingness within a particular program. Given the importance of the residency program website as a recruiting tool, this study sought to examine and compare the presence of gendered language and imagery on residency program websites across various specialties.

METHODS

A list of words considered masculine or feminine was used to evaluate residency program websites of the two most male-dominated specialties (orthopedic and thoracic surgery), female-dominated specialties (pediatrics and obstetrics and gynecology), and gender-balanced specialties (dermatology and family medicine) in the United States in 2022. Forty-five residency programs were randomly selected from each specialty across different regions of the US, with the exception of thoracic surgery of which there are only 33 programs. Masculine and feminine words were evaluated using a parsing and scraping program. Representation of female and male-presenting team members in photos on program websites was also evaluated.

RESULTS

Masculine wording occurred more frequently in male-dominated specialties compared to gender-balanced (p = 0.0030), but not female-dominated specialties (p = 0.2199). Feminine language was used more frequently in female-dominated compared to male dominated fields (p = 0.0022), but not gender balanced (p = 0.0909). The ratio of masculine-to-feminine words used was significantly higher in male-dominated specialties compared to both gender-balanced (p < 0.0001) and female-dominated specialties. (p < 0.0001). There was an average of 1, 7, and 10 female-presenting residency team members pictured on each male-dominated, gender balanced, and female-dominated specialty RPW respectively, with significantly more female-presenting team members pictured in the photographs on female-dominated specialty websites when compared to male-dominated and gender-balanced specialty websites (p < 0.0001, p = 0.014).

CONCLUSIONS

The use of gendered language and female representation in photographs varies significantly across specialties and is directly correlated with gender representation within the specialty. Given that students' perceptions of specialty programs may be affected by the use of language and photos on residency program websites, programs should carefully consider the language and pictures depicted on their program websites.

Does surgeon sex and anthropometry matter for tool usability in traditional laparoscopic surgery? A systematic review and meta-analysis

INTRODUCTION

Hand size, strength, and stature all impact a surgeon's ability to perform Traditional Laparoscopic Surgery (TLS) comfortably and effectively. This is due to limitations in instrument and operating room design. This article aims to review performance, pain, and tool usability data based on biological sex and anthropometry.

METHODS

PubMed, Embase, and Cochrane databases were searched in May 2023. Retrieved articles were screened based on whether a full-text, English article was available in which original results were stratified by biological sex or physical proportions. Article quality was discussed using the Mixed Methods Appraisal Tool (MMAT). Data were summarized in three main themes: task performance, physical discomfort, and tool usability and fit. Task completion times, pain prevalence, and grip style results between male and female surgeons formed three meta-analyses.

RESULTS

A total of 1354 articles were sourced, and 54 were deemed suitable for inclusion. The collated results showed that female participants, predominantly novices, took 2.6-30.1 s longer to perform standardized laparoscopic tasks. Female surgeons reported pain at double the frequency of their male colleagues. Female surgeons and those with a smaller glove size were consistently more likely to report difficulty and require modified (potentially suboptimal) grip techniques with standard laparoscopic tools.

CONCLUSIONS

The pain and stress reported by female or small-handed surgeons when using laparoscopic tools demonstrates the need for currently available instrument handles, including robotic hand controls, to become more size-inclusive. However, this study is limited by reporting bias and inconsistencies; furthermore, most data was collected in a simulated environment. Additional research into how anthropometric tool design impacts the live operating performance of experienced female surgeons would further inform this area of investigation.

Exposure to Otolaryngology: Impact on Female Students Considering Surgery

INTRODUCTION

Otolaryngology continues to be dominated by men. As of 2019, only 18.4% of practicing otolaryngologists were women. The goal of this project was to introduce female students to otolaryngology as a career.

METHODS

A Women in Otolaryngology event was held in September 2021. Participants included undergraduate and first- or second-year medical students from the University at Buffalo. During the event, students rotated through three skills stations working with female otolaryngology residents and attending physicians. Participants completed pre-and post-course surveys regarding their attitudes toward women in surgery and their perceptions of surgery and otolaryngology.

RESULTS

A total of 17 students that completed both the pre- and post-course surveys were included. The mean age was 22.6 years (range 18-25 yr). Specifically, 13 (76.5%) of the participants were Caucasian, three (17.6%) were Asian, and one (5.9%) was Hispanic, and 15 (88.2%) were medical students. On the pretest, 10 (55.6%) participants strongly agreed or agreed that otolaryngology as a career is open to females, while on the posttest, 16 (88.9%) participants strongly agreed or agreed (p=0.002). Nine (50.0%) participants strongly agreed or agreed that they have access to resources to help make a decision if they want to pursue a career in otolaryngology before the event, while, after the event, 16 (88.9%) participants strongly agreed or agreed (p=0.007). Five (27.8%) participants strongly agreed or agreed prior to the event that they felt confident in their knowledge of what otolaryngology includes, while afterward 15 (83.3%) strongly agreed or agreed (p=0.002).

CONCLUSION

The Women in Otolaryngology event increased participants' confidence in understanding otolaryngology, promoted understanding of resources available, and demonstrated the openness of the specialty to women.

Obstacles Deterring Medical Students From Pursuing a Career in the Field of Surgery in Jazan University, Saudi Arabia

BACKGROUND

Particularly in Saudi Arabia, there is a dearth of trained specialists in the field of surgery. Understanding the obstacles that discourage medical students and residents from pursuing a surgical career is essential for resolving this shortage. This study intended to investigate the characteristics that influence medical students and trainees at Jazan University, Saudi Arabia, to pursue a career in surgery.

METHODOLOGY

This observational study employed a descriptive, cross-sectional approach. The intended audience consisted of fourth- to sixth-year medical students and medical residents. The questionnaire gathered information on demographics, academic year, previous surgical experience, perceptions of surgery as a specialty, and variables influencing career selections.

RESULTS

Out of 413 participants, 74.3% were considering a surgical career, with 24.4% interested in general surgery, followed by cardiac surgery (14.3%) and pediatric surgery (12.4%). Factors influencing career decisions included potential income (82%), the possibility of part-time work (82%), and partial leave (74%). A significant proportion of participants agreed or strongly agreed that the incidence of suicide (62%) and the risk of depression (72%) are higher in surgical specialties. Female participants were more likely to agree that their chance of becoming a spouse could be affected by a surgical career (p=0.002) and that meeting role models could influence their choice of surgical specialty (p=0.015).

CONCLUSION

Work-life balance, long working hours, and mental health concerns are identified as variables that discourage medical students and residents from pursuing a surgical career in the study. Efforts to encourage work-life balance, minimize workload, and provide support and resources for mental health issues should help surgeons suffer less stress and burnout. Moreover, encouraging an open-minded attitude and de-stigmatizing mental health concerns in the medical field should encourage individuals to seek assistance when necessary and lower the incidence of suicide and depression. Finally, tackling gender discrimination and encouraging diversity and inclusion in surgical specialties could attract more skilled surgeons.

Medical Student Perspectives on Sexual and Gender Minority Acceptance in Surgical Specialties and Sexual and Gender Minority Education

BACKGROUND

The topics of healthcare for lesbian, gay, bisexual, transgender, and queer (LGBTQ+) patients and inclusion of LGBTQ+ health providers remain overlooked. Some specialties may be perceived as less inclusive to LGBTQ+ trainees. This study aimed to describe the perspectives of current medical students regarding LGBTQ+ education and the acceptance of LGBTQ+ trainees among different specialties.

MATERIALS AND METHODS

A cross-sectional voluntary and anonymous online survey was distributed through REDCap to all medical students (n = 495) at a state medical school. Medical students' sexuality and gender identity were queried. A descriptive statistical analysis was performed, and the responses were classified into two groups: LGBTQ+ and non-LGBTQ+.

RESULTS

A total of 212 responses were queried. Of the respondents who agreed that certain specialties are less welcoming to LGBTQ+ trainees (n = 69, 39%), orthopedic surgery, general surgery and neurosurgery were identified most frequently (84%, 76%, and 55%, respectively). After analyzing sexual orientation as an influence on choosing a future specialty for residency, only 1% of non-LGBTQ+ students indicated that their sexual orientation influences their specialty of choice in comparison with 30% of LGBTQ+ students (P < 0.001). Finally, more non-LGBTQ+ students indicated that they believe they are receiving appropriate education on caring for LGBTQ+ patients as compared to LGBTQ+ students (71% and 55%, respectively, P < 0.05).

CONCLUSIONS

LGBTQ+ students are still hesitant to pursue careers in General Surgery as compared to their non-LGBTQ+ peers. The perception that surgical specialties are the least welcoming to LGBTQ+ students continues to be a concern for all students. Further strategies of inclusivity and their effectiveness need to be studied.

An evaluation of otolaryngology resources at United States medical schools

OBJECTIVE

Otolaryngology (OTO) is a competitive specialty, and medical school factors outside an applicant's control, such as presence of OTO student resources and an affiliated OTO residency program, can impact the competitiveness of a student's application. This study sought to evaluate the extent of OTO resources United States (U.S.) allopathic medical schools provide to help their students be successful, and to evaluate for medical school factors which may bias toward inequitable distribution of student OTO resources.

METHODS

A 48-question cross-sectional survey evaluating the extent of OTO resources was distributed by email to LCME accredited U.S. allopathic medical schools in 2020 and 2021.

RESULTS

Schools with residency programs and where faculty were employed through an OTO or surgery department were more likely to have an Otolaryngology Interest Group (OIG), an Otolaryngology Medical Student Education Director (OMSED), and were more likely to provide opportunities for OTO research.

Development and evaluation of an online surgical elective for medical students

BACKGROUND

Decreased experiential learning opportunities exacerbated by the COVID-19 pandemic have increased development of online surgical educational courses. To what extent may such courses provide exposure to broad and accessible surgical education?

METHODS

Surge is a 6-week online surgical elective hosted within a virtual learning environment, covering all surgical specialties. Course content is mapped to the Royal College of Surgeons' Undergraduate Curriculum in Surgery. Each week consultant surgeons discuss their specialty in short videos on anatomy, pathology and lifestyle of a surgeon. Students also engage with learning activities; further reading lists; formative quizzes and live sessions including suturing practice. Participants were medical students undertaking third-year electives at the University of Sheffield. Pre- and post-course questionnaires investigated student interest in surgery, understanding of steps required to pursue a surgical career and confidence in surgical environments. Qualitative data was collected via free-text responses and analysed with content analysis. Quantitative data was collected using 5-point Likert scales (1 = Strongly Disagree; 5 = Strongly Agree) and analysed using the Wilcoxon signed-rank test.

RESULTS

Twenty-two students participated in Surge over five 6-week cohorts. Examination of free-text responses revealed students gained increased understanding of available surgical career options. Students felt better informed regarding different surgical specialties (median score 2.5 vs. 4, p = 0.000) and steps required to develop a surgical portfolio (median score 2 vs. 5, p = 0.000). Additionally, confidence in understanding of relevant intraoperative steps improved (median score 3 vs. 4, p = 0.000).

CONCLUSION

These data demonstrate Surge increased student confidence and understanding of surgical careers despite reduced in-person opportunities to engage with surgical education. Surge will continue to be developed and evaluated on a larger scale.

Israeli Female Physicians' Motives for Choosing Orthopedics as Their Specialty Choice

BACKGROUND

Orthopedics is not a popular field of specialization among female medical students. Therefore, the purpose of the study was to examine factors related to women's choice of orthopedics as their field of specialty, compared to those who chose other fields.

METHODS

In this cross-sectional survey, 149 female medical residents from Israel-33 specializing in orthopedics and 116 in other fields-completed a questionnaire. A comparison was held between the two groups.

RESULTS

Orthopedic residents were more likely to have received clinical training in this field during their medical studies and were more likely to have expressed a desire to specialize in orthopedics before and at the completion of their studies. In addition, orthopedic residents ascribed greater importance to job security when choosing a field of specialty and, in contrast, ascribed no importance at all to lifestyle. No difference was found between the two groups in their level of dissatisfaction as a result of their residency. However, orthopedic residents were more inclined to perceive gender discrimination in the field of orthopedics but, despite this, had a greater intention to recommend a residency in orthopedics. A negative association was found between the level of dissatisfaction as a result of the residency and intention to recommend a residency in orthopedics.

CONCLUSIONS

Differences between the two groups point to potential factors that might have been related to women's choice of orthopedics as their field of specialty. The findings may help form strategies for attracting women to specialize in orthopedics.

Orthopedic Surgery Fellowship Directors: Trends in Demographics, Education, Employment, and Institutional Familiarity

Background: Fellowship directors are assumed to be distinguished in orthopedics, but the traits and training that have enabled them to achieve their leadership positions have not been assessed. Purpose: We sought to identify common demographics, research output, and educational trends of fellowship directors in orthopedics, with an emphasis on racial, ethnic, and gender diversity. Methods: We conducted a literature review to identify published studies on fellowship directors in orthopedic surgery and found 4 cross-sectional studies of fellowship directors in spine, arthroplasty, pediatrics, and sports medicine subspecialties. Another 4 accredited orthopedic subspecialties and their fellowship directors were identified using the American College of Graduate Medical Education Public Accreditation Data System for 2020-2021 and national fellowship directories. Data endpoints included race/ethnicity, age, sex, residency and fellowship training institutions, year of fellowship completion, year of hire at current institution, year of fellowship directors appointment, and h-index. The demographics and educational backgrounds for listed fellowship directors were collected from curricula vitae (CVs). Results: Of the 537 fellowship directors identified among 8 orthopedic subspecialties, the average age was 52.9 ± 2.2 years, 5.6% (N = 30) were women, 79.1% (N = 406) were white, 12.5% (N = 64) were Asian American, 3.7% (N = 19) were African American, 2.9% (N = 15) were Middle Eastern, and 1.7% (N = 9) were Hispanic/Latino. Oncology 20% (N = 4) had the highest percentage of female fellowship directors; 37.6% (N = 202) of fellowship directors were at the same institution they trained at for residency or fellowship. Their average h-index was 18.6 ± 3.7. Conclusion: This study of fellowship directors in orthopedics found that they have a high research output and a high level of institutional familiarity. We identified a need for greater diversity in these leadership positions in both gender and race/ethnicity.

Comparison of Male and Female Surgeons' Experiences With Gender Across 5 Qualitative/Quantitative Domains

Importance

A growing body of literature has been developed with the goal of attempting to understand the experiences of female surgeons. While it has helped to address inequities and promote important programmatic improvements, work remains to be done.

Objective

To explore how practicing male and female surgeons' experiences with gender compare across 5 qualitative/quantitative domains: career aspirations, gender-based discrimination, mentor-mentee relationships, perceived barriers, and recommendations for change.

Design, Setting, and Participants

This national concurrent mixed-methods survey of Fellows of the American College of Surgeons (FACS) compared differences between male and female FACS. Differences between female FACS and female members of the Association of Women Surgeons (AWS) were also explored. A randomly selected 3:1 sample of US-based male and female FACS was surveyed between January and June 2020. Female AWS members were surveyed in May 2020.

Exposure

Self-reported gender.

Main Outcomes and Measures

Self-reported experiences with career aspirations (quantitative), gender-based discrimination (quantitative), mentor-mentee relationships (quantitative), perceived barriers (qualitative), and recommendations for change (qualitative).

Results

A total of 2860 male FACS (response rate: 38.1% [2860 of 7500]) and 1070 female FACS (response rate: 42.8% [1070 of 2500]) were included, in addition to 536 female AWS members. Demographic characteristics were similar between randomly selected male and female FACS, with the notable exception that female FACS were less likely to be married (720 [67.3%] vs 2561 [89.5%]; nonresponse-weighted P < .001) and have children (660 [61.7%] vs 2600 [90.9%]; P < .001). Compared with female FACS, female AWS members were more likely to be younger and hold additional graduate degrees (320 [59.7%] were married; 238 [44.4%] had children). FACS of both genders acknowledged positive and negative aspects of dealing with gender in a professional setting, including shared experiences of gender-based harassment, discrimination, and blame. Female FACS were less likely to have had gender-concordant mentors. They were more likely to emphasize the importance of gender when determining career aspirations and prioritizing future mentor-mentee relationships. Moving forward, female FACS emphasized the importance of avoiding competition among female surgeons. They encouraged male surgeons to acknowledge gender bias and admit their potential role. Male FACS encouraged male and female surgeons to treat everyone the same.

Conclusions and Relevance

Experiences with gender are not limited to supportive female surgeons. The results of this study emphasize the importance of recognizing the voices of all stakeholders involved when striving to promote workforce diversity and the related need to develop quality improvement/surgical education initiatives that enhance inclusion through open, honest discourse.

Enhancing Mentorship Networks through the Experiences of Women Professors of Ophthalmology

Purpose  The aim of this study is to identify and characterize women professors in ophthalmology to enhance professional development and equity of women in academic ophthalmology. Design  Cross-sectional descriptive survey study. Participants  Participants in the survey were women in ophthalmology departments who have obtained full professor rank at their respective institutions. Methods  A cross-sectional study was conducted using data from an electronic survey of women ophthalmologists and researchers who had obtained full professorship rank in ophthalmology. The survey included questions about degree obtained, training path, fellowship, length and trajectory of academic career, family or medical leave participation, previous positions, and mentorship involvement. Statistical comparisons were made based on response. Main Outcome Measures  Survey responses to questions pertaining to three domains: education and training, academic career, and mentorship. Results  Women that obtained the professor title within ophthalmology largely held Doctor of Medicine/Doctor of Osteopathic Medicine degrees, were more likely to have completed fellowship training, and on average took 11 to 15 years to obtain the full professor title. The participants held a variety of other positions and titles throughout their academic careers. The vast majority of women reported having between 1 and 3 mentors during their careers with the majority also noting they currently participate in mentoring programs. Surveys were completed by 62 (30% response rate) women full professors of ophthalmology. Conclusion  The experiences women have along the academic path to professorship are described in this survey and can help to inform junior faculty. Literature review highlights the importance of mentorship for work productivity, retention, and promotion within academic medicine which is an element seen in the vast majority of our participants' career paths. Guided by the identification of women professors within departments of ophthalmology and characterization of their experiences, a new initiative called Women Professors of Ophthalmology was formed under the Association of University Professors of Ophthalmology's organizational structure in 2021. This group that is tailored for women professors of ophthalmology to foster peer mentorship and guidance is poised to increase the retention and promotion of women in academic ophthalmology.

Why choose paediatrics? A scoping review of factors affecting the choice of paediatrics as a career

Despite being a popular speciality at the undergraduate level, paediatrics lags behind most other medical and surgical specialities for postgraduate recruitment. As many individuals decide on their future career choice while still in medical school, it is essential to identify the factors that attract individuals to a career in paediatrics. To determine the positive influencing factors determining paediatrics as a career choice. A scoping review of primary research articles was conducted using a comprehensive electronic search strategy and reported using the Preferred Reporting Items for Systematic Review and Meta-Analyses Extension for Scoping Reviews recommendations. Studies exploring medical students, junior doctors, and current paediatricians' perceptions of paediatrics were included. Factors affecting career choice were identified. Thirty-six studies out of a possible 3106 met the inclusion criteria and were included in this review. Six key influencing themes were identified. These were early undergraduate and clinical exposure to paediatrics; an attractive work-life balance; the presence of role models and mentors; an enjoyable working atmosphere and varied clinical work; a personal commitment to paediatrics; and working with children.

CONCLUSION

 Medical students are drawn by the wide clinical variety in paediatrics, enjoyable working atmosphere, and enthusiastic colleagues. Given the importance of early clinical exposure in determining student motivation, paediatrics needs to do more to advertise the wide variety of clinical and research work available, starting early in medical school. In addition, medical students need to be offered more opportunities to experience the speciality through student selected components, summer schools, or workshops, requiring coordination between medical schools and regional paediatric departments.

WHAT IS KNOWN

• Research suggests that many medical students make choices on their future career based on medical school experiences. • Paediatrics is a popular subject among medical students, however applications for the specialilty are in decline.

WHAT IS NEW

• Six key factors influencing paediatrics as a career choice have been identified, the most common being early exposure to paediatrics at medical school and lifestyle factors. • Interventions aimed at increasing student involvement in paediatrics at the undergraduate level have been shown to be associated with an increase in the number of individuals applying for the speciality following graduation.

Ophthalmology Education Leadership Attitudes Towards Mentorship of Female Medical Students

PURPOSE

Numerous studies have emphasized the influence of gender-specific mentors in medical students' career decisions, but this has not been explored fully in ophthalmology. Therefore, this study evaluated ophthalmology educators' attitudes towards female mentorship, to better understand how this may relate to medical students' career development and training.

DESIGN

Cross-sectional study.

METHODS

A 22-question survey was sent to AUPO Chairs, Program Directors, and Medical Student Educators. The number of female students applying to ophthalmology residency was compared with the number of female ophthalmology faculty using AUPO and AAMC workforce data. Student's t-tests and chi square were used for analyses, all at a threshold significance level of p<0.05.

RESULTS

75 members responded, including 30 of 72 MSEs (41.7%), 34 of 114 PDs (29.8%), and 17 of 135 Chairs (12.6%). Of respondents, 55.4% identified as female and 44.6% as male. Male and female members had 47.9% and 47.6% female mentees, respectively, (p=0.45). However, 21.2% of male and 56.1% of female members agreed that a mentee of the same gender was important, (p<0.01). Furthermore, 13 of 40 female members (32.5%) reported having a significant female mentor themselves vs. 1 of 29 male members (3%), (p<0.01).

CONCLUSIONS

Male and female AUPO members reported no difference in female mentees but females were more likely to feel gender-specific mentorship was important, suggesting room for further development of this resource. Expansion of female mentorship in ophthalmology can promote equity in training and help address the lack of female representation in leadership.

Gender Representation in Orthopaedic Surgery: A Geospatial Analysis From 2015 to 2022

Introduction

The gender disparity in orthopaedic surgery is well-established. According to our analysis, only 7.4% of practicing orthopaedic surgeons in the US are female in 2022. While there are several theories attempting to explain this gender gap, our eight years of data show that limited female representation is a self-perpetuating cycle as areas without female representation almost never improve in that regard. It appears that existing female mentorship is critical to the growth of a female orthopaedic presence in an area. In the present work, we aim to describe how gender diversity in orthopaedic surgery differs across the country, how this diversity is changing over time, and how surgeon gender diversity may be affected by the sociodemographic characteristics making up the counties where orthopaedic surgery is practiced.

Methods

A retrospective study was conducted using publicly available National Provider Identifier (NPI) data from 2015 to 2022. Orthopaedic surgeons and their genders were identified using the Provider Type and Gender data elements associated with an individual NPI. Rural-urban and metro characters were defined using the USDA Economic Research Reserve’s rural-urban continuum codes. Python was used for database building and data cleaning. GeoDa, a statistical map-based graphing software, was used to plot and assess demographic, geographic, and socioeconomic trends. Trends in gender diversity from 2015 to 2019 were analyzed for each individual year as well as the time period as an aggregate. Cluster analysis was performed to assess complex spatial patterns of variables that could not be condensed linearly or logarithmically. Moran’s I was used to measure the similarity of a Federal Information Processing System (FIPS) area code to its neighbors. Within the clustering analysis, spatial clusters were broken down into four groups of spatial outliers (High-High, High-Low, Low-High, and Low-Low) referencing a given area’s relationship with its neighbors. Factorial ANOVA between each of the four cluster types was performed using the variables provided in the article to identify significant demographic variables within the cluster analysis.

Results

There are relative hotspots of gender diversity in the Northwest, Northeast, and Southwest with relative coldspots in the Midwest and Southern US. In counties that are considered gender diversity hotspots, the total population of orthopaedic surgeons increases by 0.94 each year while the population of female orthopaedic surgeons increases by 0.2, suggesting that in areas with high gender diversity, 4.7 male orthopaedic surgeons are joining practices for every 1.0 female. In areas with low gender diversity, the population of orthopaedic surgeons increases by 0.11 surgeons each year while the slope for an increase in female orthopaedic surgeons is 0.

Conclusions 

Orthopaedic surgery lags behind other male-dominated surgical specialties in gender parity. Our analysis demonstrates that certain areas of the country including the Northwest, Northeast, and Arizona have improved gender diversity compared to the rest of the country. We also see that the rate of increase of female orthopaedic surgeons in the past seven years is highest in areas with more preexisting female orthopaedic surgeons, suggesting the importance of a “trailblazer” phenomenon in recruiting female surgeons.

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.

Gender Matters: Understanding Transitions in Surgical Education

Introduction

Diverse transitions are elemental to medical career trajectories. The effective navigation of such transitions influences a sense of belonging and wellbeing, positive relationships, and good engagement and attainment within new contexts. Using Multiple and Multidimensional Transitions (MMT) theory as an analytical lens, this paper aims to answer the research question: “What gendered transitions do female surgeons experience, and how do these gendered transitions impact them?”

Methods

We conducted a qualitative study drawing on narrative inquiry, with face-to-face and online semi-structured interviews with 29 female surgeons across nine surgical specialities in Ireland and Scotland. This paper is part of a larger study including male surgeons, other colleagues and patients of female surgeons. The female surgeons in this paper were purposively sampled using maximum variation sampling across several levels (consultants, trainees and middle-grade doctors), as well as six who had transitioned out of surgery. Framework analysis was employed to interrogate the interview data.

Results

Five overarching types of transitions were identified across surgical education but only three of these transitions—work, culture and health—were primarily experienced by female surgeons (not male surgeons so were considered gendered), thereby impacting social, academic, and psychological domains. The remaining two types of transition—education and geography—were seemingly experienced equally by female and male surgeons, so are beyond the scope of this paper focused on female surgeons’ gendered experiences.

Conclusion

This novel qualitative study drawing on MMT theory illustrates how multiple gendered transitions interact and impact female surgeons across the surgical education continuum. Aligned with MMT theory, family members and others are also purportedly affected by female surgeons’ transitions. Healthcare educators, leaders and policymakers need to better understand gendered transitions and their impacts to improve support for female surgical trainees on their educational journeys.

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.

Female insertion in neurosurgery: Evolution of a stigma break

BACKGROUND

Utilizing the Brazilian Medical Demography analysis and a literature review, we evaluated how women choose to become neurosurgeons in Brazil and around the world, specifically citing the Europe, the USA, India, and Japan.

METHODS

We utilized the Brazilian Medical Demography prepared by the Federal Council of Medicine and the Regional Council of Medicine of the State of São Paulo (2011, 2013, 2015, and 2018). We also included an evaluation of 20 articles from PubMed, the Scientific Electronic Library Online, and National Health Library databases (e.g., using descriptors "Women in neurosurgery" and "Career").

RESULTS

In Brazil in 2017, women comprised 45.6% of active doctors, but only 8.6% of all neurosurgeons. Of 20 articles identified in the literature, 50% analyzed the factors that influenced how women choose neurosurgery, 40% dealt with gender differences, while just 10% included an analysis of what it is like to be a female neurosurgeon in different countries/continents.

CONCLUSION

The participation of women in neurosurgery has increased in recent years despite the persistence of gender inequality and prejudice. More women need to be enabled to become neurosurgeons as their capabilities, manual dexterity, and judgment should be valued to improve the quality of neurosurgical health-care delivery.