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Prakash M, Hippalgaonkar K, Reddy MV, Seth A, Jayakumar T, Pranav Krishna B, Mulpur P, Reddy AG. A Cross-Sectional Study on Patient Preferences for Selecting Surgeons for Joint Replacement Surgery in India. Cureus 2024; 16:e63836. [PMID: 39099968 PMCID: PMC11297634 DOI: 10.7759/cureus.63836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/04/2024] [Indexed: 08/06/2024] Open
Abstract
Introduction This study aims to investigate the complex decision-making process of patients in India when choosing surgeons for joint replacement surgery, with a focus on both clinical and non-clinical factors influencing their preferences. Methods This was a cross-sectional observational study conducted at the KIMS-Sunshine Hospitals, Hyderabad, a high-volume tertiary care institute in India, in which patients with end-stage osteoarthritis requiring primary total knee arthroplasty were evaluated using a self-administered questionnaire, which assessed both patient-related and surgeon-related factors in choosing their joint replacement surgeon. Results A total of 210 participants were surveyed among whom the majority were females with an average age of 60.2 years with the majority belonging to the upper-middle-class socioeconomic status (48.6%, N=102). Fifty-nine percent preferred surgeons with over 20 years of experience, and 63.8% were willing to travel out-of-state for recognized expertise. Family recommendations (33.8%) and surgeon reputation (24.3%) were primary factors in surgeon selection. A vast majority (73.3%) preferred surgeons who were skilled in robotic surgery and had foreign training (32.9%). However, the majority (67.6%) did not express any gender preference. The survey highlighted a broad range of informational sources affecting decisions, including financial consideration (63.8%), personal referrals, and online platforms (17.1%). Preferences were also shaped by hospital reputation and insurance options (10.5%), illustrating a nuanced interplay of quality, cost, and personal connections in the selection process. Conclusion The findings of this survey illuminate the intricate and diverse preferences exhibited by patients when selecting a surgeon for joint replacement surgery. A significant rise in patient expectations is evident, underscoring a demand for more personalized, contemporary, and high-quality healthcare services. Importantly, geographical proximity appears to be a diminishing concern in their decision-making process. This trend presents an opportunity for centers of excellence to extend their influence and attract patients on both a regional and national level.
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Affiliation(s)
| | | | - M V Reddy
- Orthopedic Surgery, KIMS-Sunshine Hospitals, Hyderabad, IND
| | - Aditya Seth
- Orthopedics, KIMS-Sunshine Hospitals, Hyderabad, IND
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Rama E, Ekhtiari S, Thevendran G, Green J, Weber K, Khanduja V. Overcoming the Barriers to Diversity in Orthopaedic Surgery: A Global Perspective. J Bone Joint Surg Am 2023; 105:1910-1919. [PMID: 37639495 DOI: 10.2106/jbjs.23.00238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/31/2023]
Abstract
BACKGROUND Diversity in orthopaedics continues to lag behind that in other surgical specialties. This pattern exists globally and is not unique to gender or race. This review offers a global perspective on overcoming the barriers to diversity in orthopaedics. METHODS A literature search of MEDLINE and Embase was conducted and a narrative review was undertaken. Publications that discussed any aspect of diversity or solutions to diversity within orthopaedics or academic orthopaedics were identified. RESULTS A total of 62 studies were included. Studies showed that diversity in orthopaedic training is limited by structural barriers such as long hours, requirements to relocate during training, training inflexibility, and a lack of exposure to orthopaedics. Implicit bias during the selection process for training, discrimination, and a lack of role models are additional barriers that are experienced by both minority and female surgeons. The global lack of diversity suggests that there are also inherent "cultural barriers" that are unique to orthopaedics; however, these barriers are not uniformly experienced. Perceptions of orthopaedics as promoting an unhealthy work-life balance and the existence of a "boys' club" must be addressed. Strong, committed leaders can embed cultural norms, support trainees, and act as visible role models. Targeted efforts to increase diverse recruitment and to reduce bias in selection processes for medical school and specialty training will increase diversity in the "training pipeline." CONCLUSIONS Diversity in orthopaedics continues to lag behind that in other specialties. Increasing diversity is important for providing a more inclusive training environment, improving patient care, and reducing health disparities. Structural and cultural barriers need to be addressed to improve diversity in orthopaedics. Promoting a culture supportive of all surgeons is essential to reframing perceptions that may prevent individuals from even considering a career as an orthopaedic surgeon. Changing attitudes require focused efforts from committed leadership in a "top-down" approach that prioritizes diversity. The efforts from national bodies seeking to tackle the lack of diversity, as well as the establishment of organizations committed to diversity, such as the International Orthopaedic Diversity Alliance, provide reasons to be optimistic for the future.
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Affiliation(s)
- Essam Rama
- University of Cambridge, Cambridge, United Kingdom
| | - Seper Ekhtiari
- Addenbrooke's-Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | | | | | - Kristy Weber
- Penn Orthopaedics Perelman, Penn Medicine, Philadelphia, Pennsylvania
| | - Vikas Khanduja
- University of Cambridge, Cambridge, United Kingdom
- Addenbrooke's-Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
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Mirza K, Acharya PU, Crasta N, Austine J. The Ideal Orthopaedic Surgeon: Comparing Patient Preferences of Surgeon Attributes to Notions Held by Orthopaedic Postgraduates. Indian J Orthop 2023; 57:1748-1756. [PMID: 37881289 PMCID: PMC10593707 DOI: 10.1007/s43465-023-00988-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 08/25/2023] [Indexed: 10/27/2023]
Abstract
Introduction Stereotypes have been a barrier to providing patients a diverse orthopaedic workforce. Our goal was to identify stereotypes and disparities among doctors and their patients regarding the attributes that should determine a competent orthopaedic surgeon. Materials and Methods A cross-sectional descriptive multicenter study was conducted in India. Tailored questionnaires were administered to patients and orthopaedic postgraduates to determine the attributes they believe patients prefer in their orthopaedic surgeon. Likert data and data on preferred sex of the surgeon were analyzed as categorical data sets using frequency statistics. Participants were asked to rank surgeon attributes and analysis was based on frequency of an item among top 5 surgeon attributes. Results 304 patients and 91 orthopaedic postgraduates participated in the study. 70.4% and 73% of patients and 27.5% and 29.6% of postgraduates preferred an orthopaedic surgeon with greater physical strength as an outpatient consultant or operating surgeon respectively. 81% of patients had no preference of the sex of their doctor. 56% of postgraduates felt patients would prefer a male operating surgeon, none felt their patient would prefer female orthopaedic surgeon. 92.3% of the female postgraduates felt patients would prefer a male orthopaedic surgeon. Patients most often ranked years of experience, surgical outcomes, time spent with patients, reputation, and physical strength in their top 5 surgeon attributes and sex, religion, and community were given least importance. Conclusion Diversity among the orthopaedic workforce is necessary to optimize patient care. It is our collective responsibility to educate our patients and trainees and redress the misconceptions and stereotypes that plague our profession. Supplementary Information The online version contains supplementary material available at 10.1007/s43465-023-00988-2.
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Affiliation(s)
- Kiyana Mirza
- Government Hospital Hoskote, Hoskote Taluk, Bangalore, Karnataka 562114 India
| | - Prashant Upendra Acharya
- Department of Orthopaedic Surgery, Father Muller Medical College, Father Muller Road, Kankanady, Mangalore, Karnataka 575002 India
| | - Nikitha Crasta
- Department of Sports Medicine, Massachusetts General Hospital, Boston, MA 02114 USA
| | - Jose Austine
- Trauma and Orthopaedics, Portsmouth Hospitals University NHS Trust, Portsmouth, PO6 3LY UK
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Morrison LJ, Abbott AG, Mack Z, Schneider P, Hiemstra LA. What Are the Challenges Related to Family Planning, Pregnancy, and Parenthood Faced by Women in Orthopaedic Surgery? A Systematic Review. Clin Orthop Relat Res 2023; 481:1307-1318. [PMID: 36853855 PMCID: PMC10263240 DOI: 10.1097/corr.0000000000002564] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 01/03/2023] [Indexed: 03/01/2023]
Abstract
BACKGROUND Orthopaedic surgery is the surgical specialty with the lowest proportion of women. Conflicting evidence regarding the potential challenges of pregnancy and parenthood in orthopaedics, such as the implications of delayed childbearing, may be a barrier to recruitment and retainment of women in orthopaedic surgery. A summary of studies is needed to ensure that women who have or wish to have children during their career in orthopaedic surgery are equipped with the relevant information to make informed decisions. QUESTIONS/PURPOSES In this systematic review, we asked: What are the key gender-related barriers pertaining to (1) family planning, (2) pregnancy, and (3) parenthood that women in orthopaedic surgery face? METHODS Embase, MEDLINE, and PsychINFO were searched on June 7, 2021, for studies related to pregnancy or parenthood as a woman in orthopaedic surgery. Inclusion criteria were studies in the English language and studies describing the perceptions or experiences of attending surgeons, trainees, or program directors. Studies that sampled surgical populations without specific reference to orthopaedics were excluded. Quantitative and qualitative analyses were performed to identify important themes. Seventeen articles including surveys (13 studies), selective reviews (three studies), and an environmental scan (one study) met the inclusion criteria. The population sampled included 1691 attending surgeons, 864 trainees, and 391 program directors in the United States and United Kingdom. The Risk of Bias Instrument for Cross-Sectional Surveys of Attitudes and Practices tool was used to evaluate the risk of bias in survey studies. A total of 2502 women and 560 men were sampled in 13 surveys addressing various topics related to pregnancy, parenthood, and family planning during an orthopaedic career. Three selective reviews provided information on occupational hazards in the orthopaedic work environment during pregnancy, while one environmental scan outlined the accessibility of parental leave policies at 160 residency programs. Many of the survey studies did not report formal clarity, validity, or reliability assessments, therefore increasing their risk of bias. However, our analysis of the provided instruments as well as the consistency of identified themes across multiple survey studies suggests the evidence we aggregated was sufficiently robust to answer the research questions posed in the current systematic review. RESULTS These data revealed that many women have witnessed or experienced discrimination related to pregnancy and parenthood, at times resulting in a decision to delay family planning. In one study, childbearing was reportedly delayed by 67% of respondents (304 of 452) because of their career choice in orthopaedics. Orthopaedic surgeons were more likely to experience pregnancy complications (range 24% to 31%) than the national mean in the United States (range 13% to 17%). Lastly, despite these challenging conditions, there was often limited support for women who had or wished to start a family during their orthopaedic surgery career. Maternity and parental leave policies varied across training institutions, and only 55% (56 of 102) of training programs in the United States offered parental leave beyond standard vacation time. CONCLUSION The potential negative effects of these challenges on the orthopaedic gender gap can be mitigated by increasing the availability and accessibility of information related to family planning, parental leave, and return to clinical duties while working as a woman in orthopaedic surgery. Future research could seek to provide a more global perspective and specifically explore regional variation in the environment faced by pregnancy or parenting women in orthopaedic surgery. LEVEL OF EVIDENCE Level III, prognostic study.
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Affiliation(s)
| | | | - Zoe Mack
- Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Prism Schneider
- Department of Surgery, University of Calgary, Calgary, AB, Canada
| | - Laurie A. Hiemstra
- Department of Surgery, University of Calgary, Calgary, AB, Canada
- Banff Sport Medicine Foundation, Banff, AB, Canada
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Bertha N, Visser T, Haines N. New Patient Referral Patterns May Reflect Gender Biases in Orthopedics. Cureus 2023; 15:e40935. [PMID: 37496543 PMCID: PMC10368298 DOI: 10.7759/cureus.40935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/23/2023] [Indexed: 07/28/2023] Open
Abstract
Background Orthopedic surgery traditionally has been a male-dominant specialty with the lowest percentage of female residents and female faculty of all medical specialties. Prior studies demonstrate gender biases from both referring providers and patients. This study investigates surgeon, referring provider, and patient demographic differences in new patient orthopedic referrals. Methodology A retrospective chart review was performed to analyze the demographics of new patients referred to male and female orthopedic surgeons within adult reconstruction and shoulder/elbow specialties at a single academic institution. Patients and referring provider demographics were compared for male and female orthopedic surgeons. Statistical analysis utilized Student's t-test and chi-square analyses for quantitative and qualitative data, respectively. Results In total, 2,642 new patients were analyzed, with 2,084 patients being referred from a provider, and 306 patients requesting specific providers. When compared to male surgeons, female surgeons had fewer referrals from male providers (45.3% vs. 50.3%, p = 0.03) and no difference from female providers (30.6% vs, 29.9%, p = 0.72). The female adult reconstruction surgeon had fewer internal referrals compared to a male surgeon of similar experience and time at the institution (8.4% vs. 12.8%, p = 0.03). Female patients requested male surgeons more frequently than female surgeons (76.7% vs. 23.3%, p = 0.02). Conclusions New patient demographics differed between male and female orthopedic surgeons at a single academic institution with more male referring providers referring to male surgeons. Female patients requesting male orthopedic providers may reflect patient and specialty-driven biases. There remains a need for additional female representation in orthopedic surgery, and new patient referral patterns may be a marker to assess and monitor gender biases.
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Affiliation(s)
- Nicholas Bertha
- Department of Orthopaedics, Penn State Health Milton S. Hershey Medical Center, Hershey, USA
| | - Timothy Visser
- Department of Orthopaedics, Penn State Health Milton S. Hershey Medical Center, Hershey, USA
| | - Nikkole Haines
- Department of Orthopaedics, Penn State Health Milton S. Hershey Medical Center, Hershey, USA
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Paul D, Ghoshdastidar S, Halder S, Sarkar DK. Are Women Finally Joining Orthopedics in India? A Study of the Causes Limiting the Number of Women in Orthopedics in India with Steps for Furthering Progress. Indian J Orthop 2023; 57:586-595. [PMID: 37006728 PMCID: PMC10050455 DOI: 10.1007/s43465-023-00834-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 01/23/2023] [Indexed: 02/10/2023]
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Association between patient-surgeon race and gender concordance and patient-reported outcomes following breast cancer surgery. Breast Cancer Res Treat 2023; 198:167-175. [PMID: 36622543 DOI: 10.1007/s10549-022-06858-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 12/30/2022] [Indexed: 01/10/2023]
Abstract
PURPOSE Surgeon- and patient-related factors have been shown to influence patient experiences, quality of life (QoL), and surgical outcomes. We examined the association between patient-surgeon race and gender concordance with QoL after breast reconstruction. METHODS We conducted a retrospective cross-sectional analysis of patients who underwent lumpectomy or mastectomy followed by breast reconstruction over a 3-year period. We created the following categories with respect to the race and gender of a patient-surgeon triad: no, intermediate, and perfect concordance. Multivariable regression was used to correlate postoperative global (SF-12) and condition-specific (BREAST-Q) QoL performance with patient-level covariates, gender and race concordance. RESULTS We identified 375 patients with a mean (± SD) age of 57.6 ± 11.9 years, median (IQR) body mass index of 27.5 (24.0, 32.0), and median morbidity burden of 3 (2, 4). The majority of encounters were of intermediate concordance for gender (70%) and race (52%). Compared with gender-discordant triads, intermediate gender concordance was associated with higher SF-Mental scores (β, 2.60; 95% CI, 0.21-4.99, p = 0.003). Perfect race concordance (35% of encounters) was associated with significantly higher adjusted SF-Physical scores (β, 2.14; 95% CI, 0.50-4.22, p = 0.045) than the race-discordant group. There were no significant associations observed between race or gender concordance and BREAST-Q performance. CONCLUSION Race-concordant relationships following breast cancer surgery were more likely to have improved global QoL. Perfect gender concordance was not associated with variation in QoL outcomes. Policy-level interventions are needed to facilitate personalized care and optimize breast cancer surgery outcomes.
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Alomar AZ, Almonaie S, Nagshabandi KN, AlGhufaili D, Alomar M. Representation of women in orthopaedic surgery: perception of barriers among undergraduate medical students in Saudi Arabia. J Orthop Surg Res 2023; 18:19. [PMID: 36611180 PMCID: PMC9825039 DOI: 10.1186/s13018-022-03487-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 12/30/2022] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND While female participation has improved in several surgical specialties over time globally, no such increase has been observed in orthopaedic surgery over the past decades. The potential barriers to female participation are likely present from the beginning of medical education. Therefore, this study assessed the apparent lag in equal representation among men and women in orthopaedic surgery in the Kingdom of Saudi Arabia. METHODS This cross-sectional study used a questionnaire survey to investigate medical students' and interns' perceptions of women participating in orthopaedic surgery, their subspeciality preferences, and barriers preventing them from pursuing an orthopaedic career. The responses were analysed to understand general perceptions, gender-based differences, impact of clinical experiential learning, and exposure to orthopaedic surgery. RESULTS Approximately 565 medical students (49% females, 51% males) participated in the survey. Only 17% of students (11% females, 23% males) considered orthopaedic surgery as their future career option. While 31% of female and 17% of male students disagreed with the concept of female-appropriate orthopaedic subspecialties, most of the remaining male and female students perceived paediatric orthopaedics as a female-appropriate subspecialty. Concerning equal representation of women, gender bias and lack of a strong physique were the most frequently selected barriers by female and male students, respectively. Patient preference for male orthopaedicians, gender discrimination, social and family commitments, and need for physical strength were all perceived as barriers for women in orthopaedics. Overall, clinical experience and orthopaedic exposure did not significantly improve the likelihood of female students in choosing orthopaedic surgery as a career. CONCLUSIONS The bias against women in orthopaedic careers is prevalent among medical students early in their academic years. Clinical experience and exposure to orthopaedic surgery should be improved to make a significant impact on female participation in orthopaedic careers. Career building efforts in terms of improved career opportunities, career counselling, flexible working hours, social and family related adjustments and implementation of mentorship/research/fellowship programmes for females are needed to reduce gender discrimination and improve female orthopaedic participation. Furthermore, process improvements may yield greater flexibility for women pursuing the challenging field while accommodating other barriers faced by women in orthopaedic surgery.
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Affiliation(s)
- Abdulaziz Z. Alomar
- grid.56302.320000 0004 1773 5396Head of Arthroscopy and Sports Medicine Division, Orthopaedic Department, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Shahd Almonaie
- grid.411335.10000 0004 1758 7207College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | | | - Deema AlGhufaili
- grid.412149.b0000 0004 0608 0662College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Manar Alomar
- grid.412149.b0000 0004 0608 0662College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
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Khan S. The impact of gendered experiences on female medical students' specialty choice: A systematic review. Am J Surg 2023; 225:33-39. [PMID: 36435655 DOI: 10.1016/j.amjsurg.2022.10.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 10/04/2022] [Accepted: 10/12/2022] [Indexed: 11/21/2022]
Abstract
BACKGROUND Women make up 50% of American medical school graduates, yet are not equally represented in the vast spectrum of medical specialties. Many fields within medicine remain male dominated. This systematic review will explore social factors that affect female medical students' specialty choice. HYPOTHESIS Gendered experiences influence the specialty choice of female medical students, resulting in their concentration in a specific cohort of specialties. METHODS Studies were gathered by searching MEDLINE/Pubmed and EBSCOhost for sociological factors that impact female medical students' specialty choice. RESULTS 34 articles were selected for this systematic review. Factors that contribute to gender segregation within medical specialties include gender discrimination, socialization, lifestyle considerations, negative perceptions of male-dominated medical specialties and lack of female role models. CONCLUSION This systematic review supported the hypothesis that gendered experiences impact women's medical specialty choice, and thus result in their concentration in specialties such as family medicine, pediatrics and obstetrics and gynecology.
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Affiliation(s)
- Sana Khan
- Detroit Medical Center/Wayne State University School of Medicine, United States.
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10
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Hull B, Pestrin O, Brennan CM, Hackney R, Scott CE. Women in Surgery Events Alone do not Change Medical Student Perceptions of Gender Bias and Discrimination in Orthopaedic Surgery. Front Surg 2022; 9:905558. [PMID: 35693302 PMCID: PMC9174672 DOI: 10.3389/fsurg.2022.905558] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Accepted: 05/06/2022] [Indexed: 12/05/2022] Open
Abstract
Aims This study investigated the perceptions of medical students regarding the barriers to pursuing a career in trauma and orthopaedics (T&O); and whether these perceptions were altered by attending an event promoting women in T&O. Methods An event consisting of presentations and interactive sessions from two female T&O trainees was hosted online. Attendees completed pre and post-event questionnaires. Students were asked about their previous exposure to T&O, perceptions of gender imbalances in T&O and what barriers they perceived prevented women from entering T&O. Univariate analysis was performed to identify changes in perceptions following the event. Results Pre-event questionnaires were completed by 102 people; and post-event by 52. Although 64/102 respondents were considering a career in T&O, 26/102 were dissuaded by perceived gender disparities. Perceptions of gender disparities were significantly higher in UK based attendees compared to other nationalities (p = 0.047). Attendees were more likely to want to pursue a career in T&O if they had been directly exposed at medical school (p = 0.044), but exposure did not alter perceptions of women in T&O. The most common perceived barrier was the orthopaedic stereotype followed by male dominated workplace culture, and lack of female role models. Pre and post-event responses did not differ significantly for any areas examined. Conclusion There are significant concerns amongst medical students regarding gender based discrimination within T&O, and these perceptions were not altered by attending a one-off women in T&O event. Early exposure to T&O appears important to improve interest in orthopaedics, whereas negative stereotyping is a barrier.
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Affiliation(s)
- Bethany Hull
- Edinburgh Medical School, University of Edinburgh, Edinburgh, United Kingdom
- Correspondence: Bethany Hull
| | - Olivia Pestrin
- Edinburgh Medical School, University of Edinburgh, Edinburgh, United Kingdom
| | - Caitlin M. Brennan
- Edinburgh Orthopaedics, Department of Trauma and Orthopaedic Surgery, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
| | - Rosie Hackney
- Edinburgh Orthopaedics, Department of Trauma and Orthopaedic Surgery, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
| | - Chloe E.H. Scott
- Edinburgh Medical School, University of Edinburgh, Edinburgh, United Kingdom
- Edinburgh Orthopaedics, Department of Trauma and Orthopaedic Surgery, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
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Iguina-González E, Olivella G, Ramos-Vicente A, Fantauzzi A, Dávila A, Mangual D, Torres-Lugo NJ, Ramos G, Ramírez N, Otero-López A, Dávila-Parrilla A. Orthopedic Provider Gender Preference Among Patients in an Orthopedic Surgery Residency Program of a Hispanic American Community. WOMEN'S HEALTH REPORTS (NEW ROCHELLE, N.Y.) 2022; 3:345-350. [PMID: 35415717 PMCID: PMC8994432 DOI: 10.1089/whr.2021.0126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/22/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND There are limited data regarding the gender preferences of Hispanic Americans when selecting their orthopedic surgeon. This study aimed to evaluate the gender preferences of Hispanic Americans when choosing a physician as their orthopedic provider. MATERIALS AND METHODS A cross-sectional survey was administered to all consecutive Hispanic American patients treated at the outpatient orthopedic clinics of a tertiary medical center in Puerto Rico between October 4, 2019 and March 4, 2020. Sociodemographic status and opinion of gender preference in orthopedic surgery were assessed and analyzed between female and male respondents. RESULTS A total of 628 surveys were completed. There were 343 (54.6%) females and 285 (45.4%) males with an average age of 51.0 ± 13.0 years. A significantly higher portion of female respondents was widowed (p = 0.01), had a higher educational level (p = 0.02), were unemployed (p = 0.01), and had a lower individual annual income salary (p = 0.04); when compared with males. Most of the respondents had no gender preference (91.1% = 572/628) for an orthopedic provider. Among those with a gender preference, 5.1% (32/628) preferred a male surgeon, and 3.8% (24/628) preferred a female surgeon. No significant difference was found between male and female respondents in the opinion of an orthopedic provider. CONCLUSIONS This study illustrates that Hispanic Americans have no gender preference when choosing an orthopedic provider. Therefore, patient preference should not be considered a factor contributing to women's under-representation in our orthopedic surgery training program. Our findings may also assist future studies in search of other indications attributed to the under-representation of females in this field.
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Affiliation(s)
- Elena Iguina-González
- Department of Orthopaedic Surgery, University of Puerto Rico, Medical Sciences Campus, San Juan, Puerto Rico
| | - Gerardo Olivella
- Department of Orthopaedic Surgery, University of Puerto Rico, Medical Sciences Campus, San Juan, Puerto Rico
| | - Andrea Ramos-Vicente
- Department of Internal Medicine-Pediatrics, University of Puerto Rico, Medical Sciences Campus, San Juan, Puerto Rico
| | - Andrés Fantauzzi
- Department of Surgery, University of Puerto Rico, Medical Sciences Campus, San Juan, Puerto Rico
| | - Ana Dávila
- School of Medicine, University of Puerto Rico, Medical Sciences Campus, San Juan, Puerto Rico
| | - Danny Mangual
- Department of Orthopaedic Surgery, University of Puerto Rico, Medical Sciences Campus, San Juan, Puerto Rico
| | - Norberto J. Torres-Lugo
- Department of Orthopaedic Surgery, University of Puerto Rico, Medical Sciences Campus, San Juan, Puerto Rico
| | - Gladys Ramos
- Department of Orthopaedic Surgery, University of Puerto Rico, Medical Sciences Campus, San Juan, Puerto Rico
| | - Norman Ramírez
- Department of Pediatric Orthopaedic Surgery, Mayaguez Medical Center, Mayaguez, Puerto Rico
| | - Antonio Otero-López
- Department of Orthopaedic Surgery, University of Puerto Rico, Medical Sciences Campus, San Juan, Puerto Rico
| | - Ariel Dávila-Parrilla
- Department of Orthopaedic Surgery, University of Puerto Rico, Medical Sciences Campus, San Juan, Puerto Rico
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Falavigna A, Ramos MB, de Farias FAC, Britz JPE, Dagostini CM, Orlandin BC, Corso LL, Morello SL, Kapatkin AS, Topalovic T, Allen M. Perception of gender discrimination among spine surgeons across Latin America: a web-based survey. Spine J 2022; 22:49-57. [PMID: 33852964 DOI: 10.1016/j.spinee.2021.04.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 04/05/2021] [Accepted: 04/06/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Female physicians rarely choose spine surgery as their specialty. Although the specialty's nature and its associated lifestyle are potential barriers, gender-related issues may play an important part. PURPOSE To evaluate the gender discrimination among spine surgeons across Latin America. STUDY DESIGN Cross-sectional survey. PATIENT SAMPLE The participants in this study were 223 AO Spine Latin America (AOSLA) registered members who answered the web-based survey. OUTCOME MEASURES Personal and professional demographics; gender-related objective and subjective experiences regarding career and personal life. METHODS A survey link containing a 24-item questionnaire was sent to the members' e-mails in September 2019. The survey was designed to evaluate the perception of gender discrimination by spine surgeons during their academic and professional lives. RESULTS Out of 223 members who answered the survey, 196 (87.96%) were male and 27 (12.11%) female. Most were orthopedic surgeons (64.13%), ≥40 years of age (55.16%), and had <20 years of experience (69.95%). Gender discrimination was more frequent among women than among men (66.67% vs. 1.02%), as did discouragement from becoming a spine surgeon, orthopedic surgeon, or neurosurgeon (81.48% vs. 0.51%). Females reported higher rates of sexual harassment (44.44% vs. 7.65%) and more often felt disadvantaged because of gender (55.56% vs. 2.55%). Working harder than men to achieve the same prestige and lack of female mentorship were the most common obstacles reported by women (55.56%). Residency/fellowship influenced the decision to postpone/avoid having children for 66.67% of women but only 37.75% of men. Creation of a Women's Committee in AO Spine was supported by 74.07% of women and 38.78% of men. CONCLUSIONS Gender-based discrimination affects women more frequently than men in spine surgery. These experiences likely contribute to the low prevalence of female spine surgeons. Efforts to mitigate bias and support the professional development of women in neurosurgery, orthopedics and spine communities are encouraged.
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Affiliation(s)
- Asdrubal Falavigna
- Post-Graduation Program in Health Sciences, University of Caxias do Sul, Rua General Arcy da Rocha Nóbrega, 401/602, CEP: 95040-290, RS, Brazil.
| | - Miguel Bertelli Ramos
- Post-Graduation Program in Health Sciences, University of Caxias do Sul, Rua General Arcy da Rocha Nóbrega, 401/602, CEP: 95040-290, RS, Brazil
| | | | - João Pedro Einsfeld Britz
- Post-Graduation Program in Health Sciences, University of Caxias do Sul, Rua General Arcy da Rocha Nóbrega, 401/602, CEP: 95040-290, RS, Brazil
| | - Carolina Matté Dagostini
- Post-Graduation Program in Health Sciences, University of Caxias do Sul, Rua General Arcy da Rocha Nóbrega, 401/602, CEP: 95040-290, RS, Brazil
| | - Bruna Caroline Orlandin
- Post-Graduation Program in Health Sciences, University of Caxias do Sul, Rua General Arcy da Rocha Nóbrega, 401/602, CEP: 95040-290, RS, Brazil
| | - Leandro Luis Corso
- Post-Graduation Program in Health Sciences, University of Caxias do Sul, Rua General Arcy da Rocha Nóbrega, 401/602, CEP: 95040-290, RS, Brazil
| | - Samantha L Morello
- University of Wisconsin-Madison, Department of Surgical Sciences, 2015 Linden Dr.Madison, WI 53706, USA
| | - Amy S Kapatkin
- University of California-Davis, 1 Shields Ave, Davis, CA 95616, USA
| | | | - Matthew Allen
- University of Cambridge, The Old Schools, Trinity Ln, Cambridge CB2 1TN, UK
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Tan R, Bond E, Muir D. Perceived barriers to a career in orthopaedic surgery for women: A comparison between Orthopaedic and general surgery. ANZ J Surg 2021; 91:1650-1651. [PMID: 34506058 DOI: 10.1111/ans.17112] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Revised: 06/14/2021] [Accepted: 07/15/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Ruth Tan
- Waikato Hospital, Hamilton, New Zealand
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Iglesias B, Jeong H, Bengs BC, Sanders DP, SooHoo NF, Buerba RA. Total joint replacement surgeon choice: A qualitative analysis in a medicare population. J Natl Med Assoc 2021; 113:693-700. [PMID: 34474928 DOI: 10.1016/j.jnma.2021.08.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 07/24/2021] [Accepted: 08/09/2021] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Previous research has shown that patients from historically marginalized groups in the United States tend to have poorer outcomes after joint replacement surgery and that they are less likely to receive joint replacement surgery at high-volume hospitals. However, little is known regarding how this group of patients chooses their joint replacement surgeon. The purpose of this study was to understand the factors influencing the choice of joint replacement surgeon amongst a diverse group of patients. METHODS Semi-structured interviews were conducted with Medicare patients who underwent a hip or knee replacement within the last 24 months (N = 38) at an academic and community hospital. Interviews were audio recorded, transcribed and verified for accuracy. Transcripts were reviewed using iterative content analysis to extract key themes related to how respondents chose their joint replacement surgeon. RESULTS AND DISCUSSION MD referral/recommendation appears to be the strongest factor influencing joint replacement surgeon choice. Other key considerations are hospital reputation and surgeon attributes-including operative experience, communication skills, and participation in shared decision-making. Gender/ethnicity of a surgeon, industry payments to surgeons, number of publications and cost did not play a large role in surgeon choice. CONCLUSION AND CLINICAL RELEVANCE The process of choosing a joint replacement surgeon is a complex decision-making process with several factors at play. Despite growing availability of information regarding surgeons, patients largely relied on referrals for choosing their joint replacement surgeon regardless of ethnicity. Referring physicians need to ensure that patients are able to access hospital and surgeon outcomes, operative volume, and industry-payment information to learn more about their orthopedic surgeons in order to make an informed choice.
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Affiliation(s)
- Brenda Iglesias
- Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, Room 76-143 CHS, 10833 Le Conte Avenue, Los Angeles, CA, 90095 USA; Charles R. Drew University of Medicine and Science, 1731 E 120th St, Los Angeles, CA, 90059 USA
| | - Hajun Jeong
- John Peter Smith Hospital, 1500 S. Main St, Fort Worth, Texas, 76104 USA
| | - Benjamin C Bengs
- St. John's Medical Center, 2001 Santa Monica Blvd, Suite 760, Santa Monica, CA 90404 USA
| | - Don P Sanders
- Torrance Memorial Medical Center, 23560 Crenshaw Blvd, Suite 102, Torrance, CA 90505 USA
| | - Nelson F SooHoo
- Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, Room 76-143 CHS, 10833 Le Conte Avenue, Los Angeles, CA, 90095 USA
| | - Rafael A Buerba
- Banner Health Medical Center, 7701 W. Aspera Blvd, Suite 102, Glendale, AZ, 85308 USA.
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15
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Errani C, Tsukamoto S, Kido A, Yoneda A, Bondi A, Zora F, Soucacos F, Mavrogenis AF. Women and men in orthopaedics. SICOT J 2021; 7:20. [PMID: 33812468 PMCID: PMC8019566 DOI: 10.1051/sicotj/2021020] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Accepted: 03/03/2021] [Indexed: 11/14/2022] Open
Abstract
PURPOSE To compare and discuss the gender disparities in the Orthopaedic specialty. METHODS We reviewed the literature to find the rates of women applying for an orthopaedic residency, fellowship, and academic career program, to understand the causes of the disparities in women in orthopaedics, and how this relates to orthopaedic surgical practice. RESULTS The idea that men and women are different and have different working styles and skills and the belief that males are more dominant and more status-worthy than females leads to gender barriers and stereotypes that restrict women from entering male-dominated specialties. It is important to mention that equivalent barriers restrict men from pursuing female-dominated specialties such as Gynecology. Economic disparities and gender stereotypes that divide medical specialties into masculine and feminine, creating a gender gap in health care are major concerns. However, the number of women in the health sector is expected to increase due to the growing amount of female students that are expected to soon graduate. A leadership gender gap also exists; although women consist of 70% of the health care workforce they occupy only 25% of leadership positions. CONCLUSION The existence of gender-based disparities in healthcare is multifactorial. The explanation behind the existence of a so-called gender gap lies in organizational and individual factors. Early development and family relations, the decision between work and life balance, personal choices and interests, as well as working conditions, absence of role models and mentorship and institutional policies make gender disparities even more evident.
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Affiliation(s)
- Costantino Errani
- Department of Orthopaedic Oncology, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Shinji Tsukamoto
- Department of Orthopaedic Surgery, Nara Medical University, 634-8521 Nara, Japan
| | - Akira Kido
- Department of Rehabilitation Medicine, Nara Medical University, 634-8521 Nara, Japan
| | - Azusa Yoneda
- Department of Orthopaedic Surgery, Nara Medical University, 634-8521 Nara, Japan
| | - Alice Bondi
- Department of Orthopaedic Oncology, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Frida Zora
- European University of Cyprus, 2404 Nicosia, Cyprus
| | - Fotini Soucacos
- First Department of Orthopaedics, National and Kapodistrian University of Athens, School of Medicine, 157 72 Athens, Greece
| | - Andreas F Mavrogenis
- First Department of Orthopaedics, National and Kapodistrian University of Athens, School of Medicine, 157 72 Athens, Greece
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16
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Lutz PM, Lenz J, Achtnich A, Geyer S. [Female doctors in orthopedics and trauma surgery in Germany: a current status quo]. DER ORTHOPADE 2020; 50:713-721. [PMID: 33294942 PMCID: PMC8416886 DOI: 10.1007/s00132-020-04048-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 11/13/2020] [Indexed: 11/02/2022]
Abstract
BACKGROUND Gender-specific differences in the workplace in general and in the field of orthopedics and trauma surgery in particular are still clearly identifiable, and are becoming more and more pronounced in the social consciousness. OBJECTIVE Analysis of the gender-specific development in the specialist field of orthopedics and trauma surgery in Germany over the past 15 years and a survey of the status quo. METHODS Assessment of the development of female graduates in the study of human medicine, the proportion of women in accredited and clinical care and the gender-specific acquisition of an additional orthopedic/trauma surgical title. Evaluation of gender-specific numbers of members or participants in the relevant professional associations and the largest German conferences on orthopedics and trauma surgery, as well as the habilitation figures in the field of orthopedics. RESULTS AND DISCUSSION The proportion of female doctors in various fields of orthopedics and trauma surgery in the clinic and in science is increasing. There is still a clear discrepancy in leading positions in clinics, in the acquisition of an additional title, and on the boards of professional associations. In some fields, such as pediatric and hand/foot/ankle surgery, the proportion of women is higher than in other sub-areas of orthopedics and trauma surgery.
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Affiliation(s)
- Patricia M Lutz
- Abteilung und Poliklinik für Sportorthopädie, Klinikum rechts der Isar, TU München, Ismaningerstr. 22, 81675, München, Deutschland.
| | - Julia Lenz
- Zentrum für Orthopädie und Unfallchirurgie, Uniklinikum Marburg, Marburg, Deutschland
| | - Andrea Achtnich
- Abteilung und Poliklinik für Sportorthopädie, Klinikum rechts der Isar, TU München, Ismaningerstr. 22, 81675, München, Deutschland
| | - Stephanie Geyer
- Abteilung und Poliklinik für Sportorthopädie, Klinikum rechts der Isar, TU München, Ismaningerstr. 22, 81675, München, Deutschland
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Halim UA, Elbayouk A, Ali AM, Cullen CM, Javed S. The prevalence and impact of gender bias and sexual discrimination in orthopaedics, and mitigating strategies. Bone Joint J 2020; 102-B:1446-1456. [PMID: 33135433 DOI: 10.1302/0301-620x.102b11.bjj-2020-0982.r1] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS Gender bias and sexual discrimination (GBSD) have been widely recognized across a range of fields and are now part of the wider social consciousness. Such conduct can occur in the medical workplace, with detrimental effects on recipients. The aim of this review was to identify the prevalence and impact of GBSD in orthopaedic surgery, and to investigate interventions countering such behaviours. METHODS A systematic review was conducted by searching Medline, EMCARE, CINAHL, PsycINFO, and the Cochrane Library Database in April 2020, and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines to which we adhered. Original research papers pertaining to the prevalence and impact of GBSD, or mitigating strategies, within orthopaedics were included for review. RESULTS Of 570 papers, 27 were eligible for inclusion. These were published between 1998 and 2020. A narrative review was performed in light of the significant heterogeneity displayed by the eligible studies. A total of 13 papers discussed the prevalence of GBSD, while 13 related to the impact of these behaviours, and six discussed mitigating strategies. GBSD was found to be common in the orthopaedic workplace, with all sources showing women to be the subjects. The impact of this includes poor workforce representation, lower salaries, and less career success, including in academia, for women in orthopaedics. Mitigating strategies in the literature are focused on providing female role models, mentors, and educational interventions. CONCLUSION GBSD is common in orthopaedic surgery, with a substantial impact on sufferers. A small number of mitigating strategies have been tested but these are limited in their scope. As such, the orthopaedic community is obliged to participate in more thoughtful and proactive strategies that mitigate against GBSD, by improving female recruitment and retention within the specialty. Cite this article: Bone Joint J 2020;102-B(11):1446-1456.
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Affiliation(s)
- Usman A Halim
- Trauma and Orthopaedic Surgery Department, North Manchester General Hospital, Manchester, UK
| | - Abdulrahman Elbayouk
- Trauma and Orthopaedic Surgery Department, North Manchester General Hospital, Manchester, UK
| | - Adam M Ali
- Trauma and Orthopaedic Surgery Department, London North West University Healthcare NHS Trust, London, UK
| | - Clare M Cullen
- Trauma and Orthopaedic Surgery Department, Burnley General Hospital, Burnley, UK
| | - Saqib Javed
- Trauma and Orthopaedic Surgery Department, North Manchester General Hospital, Manchester, UK
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Xepoleas MD, Munabi NCO, Auslander A, Magee WP, Yao CA. The experiences of female surgeons around the world: a scoping review. HUMAN RESOURCES FOR HEALTH 2020; 18:80. [PMID: 33115509 PMCID: PMC7594298 DOI: 10.1186/s12960-020-00526-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 10/15/2020] [Indexed: 05/25/2023]
Abstract
INTRODUCTION The Lancet Commission for Global Surgery identified an adequate surgical workforce as one indicator of surgical care accessibility. Many countries where women in surgery are underrepresented struggle to meet the recommended 20 surgeons per 100,000 population. We evaluated female surgeons' experiences globally to identify strategies to increase surgical capacity through women. METHODS Three database searches identified original studies examining female surgeon experiences. Countries were grouped using the World Bank income level and Global Gender Gap Index (GGGI). RESULTS Of 12,914 studies meeting search criteria, 139 studies were included and examined populations from 26 countries. Of the accepted studies, 132 (95%) included populations from high-income countries (HICs) and 125 (90%) exclusively examined populations from the upper 50% of GGGI ranked countries. Country income and GGGI ranking did not independently predict gender equity in surgery. Female surgeons in low GGGI HIC (Japan) were limited by familial support, while those in low income, but high GGGI countries (Rwanda) were constrained by cultural attitudes about female education. Across all populations, lack of mentorship was seen as a career barrier. HIC studies demonstrate that establishing a critical mass of women in surgery encourages female students to enter surgery. In HICs, trainee abilities are reported as equal between genders. Yet, HIC women experience discrimination from male co-workers, strain from pregnancy and childcare commitments, and may suffer more negative health consequences. Female surgeon abilities were seen as inferior in lower income countries, but more child rearing support led to fewer women delaying childbearing during training compared to North Americans and Europeans. CONCLUSION The relationship between country income and GGGI is complex and neither independently predict gender equity. Cultural norms between geographic regions influence the variability of female surgeons' experiences. More research is needed in lower income and low GGGI ranked countries to understand female surgeons' experiences and promote gender equity in increasing the number of surgical providers.
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Affiliation(s)
- Meredith D. Xepoleas
- Division of Plastic and Maxillofacial Surgery, Children’s Hospital Los Angeles, Los Angeles, CA USA
- Operation Smile Inc, Virginia Beach, Virginia Beach, VA USA
| | - Naikhoba C. O. Munabi
- Operation Smile Inc, Virginia Beach, Virginia Beach, VA USA
- Division of Plastic and Reconstructive Surgery, Keck School of Medicine, 1510 San Pablo St, Suite 415, Los Angeles, CA USA
| | - Allyn Auslander
- Division of Plastic and Maxillofacial Surgery, Children’s Hospital Los Angeles, Los Angeles, CA USA
| | - William P. Magee
- Division of Plastic and Maxillofacial Surgery, Children’s Hospital Los Angeles, Los Angeles, CA USA
- Operation Smile Inc, Virginia Beach, Virginia Beach, VA USA
- Division of Plastic and Reconstructive Surgery, Keck School of Medicine, 1510 San Pablo St, Suite 415, Los Angeles, CA USA
- Division of Plastic Surgery, Shriners Hospital for Children, Los Angeles, CA USA
| | - Caroline A. Yao
- Operation Smile Inc, Virginia Beach, Virginia Beach, VA USA
- Division of Plastic and Reconstructive Surgery, Keck School of Medicine, 1510 San Pablo St, Suite 415, Los Angeles, CA USA
- Division of Plastic Surgery, Shriners Hospital for Children, Los Angeles, CA USA
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Halim UA, Elbayouk A, Ali AM, Cullen CM, Javed S. The prevalence and impact of gender bias and sexual discrimination in orthopaedics, and mitigating strategies. Bone Joint J 2020:1-11. [PMID: 32951434 DOI: 10.1302/0301-620x.102b9.bjj-2020-0982.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS Gender bias and sexual discrimination (GBSD) have been widely recognized across a range of fields and are now part of the wider social consciousness. Such conduct can occur in the medical workplace, with detrimental effects on recipients. The aim of this review was to identify the prevalence and impact of GBSD in orthopaedic surgery, and to investigate interventions countering such behaviours. METHODS A systematic review was conducted by searching Medline, EMCARE, CINAHL, PsycINFO, and the Cochrane Library Database in April 2020, and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines to which we adhered. Original research papers pertaining to the prevalence and impact of GBSD, or mitigating strategies, within orthopaedics were included for review. RESULTS Of 570 papers, 27 were eligible for inclusion. These were published between 1998 and 2020. A narrative review was performed in light of the significant heterogeneity displayed by the eligible studies. A total of 13 papers discussed the prevalence of GBSD, while 13 related to the impact of these behaviours, and six discussed mitigating strategies. GBSD was found to be common in the orthopaedic workplace, with all sources showing women to be the subjects. The impact of this includes poor workforce representation, lower salaries, and less career success, including in academia, for women in orthopaedics. Mitigating strategies in the literature are focused on providing female role models, mentors, and educational interventions. CONCLUSION GBSD is common in orthopaedic surgery, with a substantial impact on sufferers. A small number of mitigating strategies have been tested but these are limited in their scope. As such, the orthopaedic community is obliged to participate in more thoughtful and proactive strategies that mitigate against GBSD, by improving female recruitment and retention within the specialty.
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Affiliation(s)
- Usman A Halim
- Trauma and Orthopaedic Surgery Department, North Manchester General Hospital, Manchester, UK
| | - Abdulrahman Elbayouk
- Trauma and Orthopaedic Surgery Department, North Manchester General Hospital, Manchester, UK
| | - Adam M Ali
- Trauma and Orthopaedic Surgery Department, London North West University Healthcare NHS Trust, London, UK
| | - Clare M Cullen
- Trauma and Orthopaedic Surgery Department, Burnley General Hospital, Burnley, UK
| | - Saqib Javed
- Trauma and Orthopaedic Surgery Department, North Manchester General Hospital, Manchester, UK
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20
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Hiemstra LA, Wittman T, Mulpuri K, Vezina C, Kerslake S. Dissecting disparity: improvements towards gender parity in leadership and on the podium within the Canadian Orthopaedic Association. J ISAKOS 2019. [DOI: 10.1136/jisakos-2019-000290] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
ObjectivesThe purpose of this paper was to analyse the 15-year trend of women in leadership roles within the Canadian Orthopaedic Association (COA). This included not only leadership positions at the committee level in the association but also the more visible podium positions in the annual meeting programme: research podium and poster presentations, session moderators, panellists and faculty.MethodsData on the numbers of male and female members were gathered from COA membership records for the most recent 5 years (2014–2018), as well as for 10 years previous (2009) and 15 years previous (2004). Male and female representation on COA committees, as well as the number of presenters at the annual meeting was calculated. Descriptive data were generated to compare the changes in gender representation over time.ResultsIn Canada, in 2018, 11.2% of orthopaedic surgeons were female. Within the COA, 17.6% of the members are female, with active female surgeons comprising 11.6% of the total membership. The largest increase in representation of women within the COA is in the trainee category which is 25.3% female. At the 2018 annual meeting, 25% of the attendees were women, with 22% of all podium appearances by women. Not including research presentations, women participated as faculty in 11% of the appearances at the 2018 annual meeting.ConclusionIn conclusion, gender parity is not yet a reality in Canadian orthopaedics; however, the number of females in leadership roles and on the podium is consistent with the current gender diversity within the COA membership. Further efforts will be required to improve gender diversity as well as to encourage female medical students to consider orthopaedics as a specialty. The availability of female role models that are visible on the podium and in leadership positions may be one strategy to encourage the journey toward gender parity.
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Okike K, Phillips DP, Swart E, O'Connor MI. Orthopaedic Faculty and Resident Sex Diversity Are Associated with the Orthopaedic Residency Application Rate of Female Medical Students. J Bone Joint Surg Am 2019; 101:e56. [PMID: 31220032 DOI: 10.2106/jbjs.18.00320] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The representation of women in orthopaedics in the United States remains among the lowest in all fields of medicine, and prior research has suggested that this underrepresentation may stem from lower levels of interest among female medical students. Of the many proposed reasons for this lack of interest, the male-dominated nature of the field is one of the most commonly cited. The purpose of this study was to determine the degree to which the representation of women among orthopaedic faculty and residents influences female medical students at that institution to apply for a residency in orthopaedics. METHODS Using data provided by the Association of American Medical Colleges, we identified all U.S. medical schools that were affiliated with an orthopaedic surgery department and an orthopaedic surgery residency program (n = 107). For each institution, data on the representation of women among the orthopaedic faculty and residents from 2014 through 2016 were collected, as well as data on the proportion of female medical school graduates who applied to an orthopaedic residency program from 2015 through 2017. The association between institutional factors and the female medical student orthopaedic application rate was assessed. RESULTS Of 22,707 women who graduated from medical school during the 3-year study period, 449 (1.98%) applied to an orthopaedic surgery residency program. Women who attended medical school at institutions with high orthopaedic faculty sex diversity were more likely to apply for a residency in orthopaedics (odds ratio [OR], 1.30; 95% confidence interval [CI], 1.04 to 1.64; p = 0.023), as were women who attended medical school at institutions with high orthopaedic resident sex diversity (OR, 1.30; 95% CI, 1.05 to 1.61; p = 0.019). CONCLUSIONS In this study, we found that increased sex diversity among orthopaedic faculty and residents was associated with a greater likelihood that female medical students at that institution would apply for an orthopaedic residency. These results suggest that at least some of the factors currently impeding female medical student interest in orthopaedics may be modifiable. These findings may have important implications for efforts to improve the sex diversity of the field of orthopaedics going forward.
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Affiliation(s)
- Kanu Okike
- Department of Orthopaedics, Kaiser Permanente Moanalua Medical Center, Honolulu, Hawaii
| | - Donna P Phillips
- Department of Orthopaedic Surgery, NYU Langone Orthopedic Hospital, New York, NY
| | - Eric Swart
- Department of Orthopaedic Surgery and Rehabilitation, University of Massachusetts, Worcester, Massachusetts
| | - Mary I O'Connor
- Center for Musculoskeletal Care, Yale School of Medicine, New Haven, Connecticut
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Revisiting the Gender Gap in Orthopaedic Surgery: Investigating the Relationship Between Orthopaedic Surgery Female Faculty and Female Residency Applicants. J Am Acad Orthop Surg 2019; 27:295-300. [PMID: 30278014 DOI: 10.5435/jaaos-d-17-00686] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
INTRODUCTION Although women now constitute approximately half of all graduating medical students, orthopaedic surgery continues to lag behind in its ability to recruit female applicants. One hypothesis for this discrepancy is the lack of female faculty mentors at academic institutions. The three objectives of this study were the following: (1) to quantify the proportion of female orthopaedic surgery residency applicants, (2) to quantify the proportion of female orthopaedic surgery faculty, and (3) to investigate the relationship between female orthopaedic surgery faculty at an academic institution and the corresponding number of female orthopaedic surgery residency applicants. METHODS Data from the Association of American Medical Colleges from 2005 to 2014 were used to calculate the number of medical school graduates, the number of orthopaedic surgery residency applicants, and the number of orthopaedic full-time faculty in the United States. Institutions were excluded if they had incomplete data. A Spearman rank correlation was used to assess for a correlation between the 9-year total number of female orthopaedic surgery applicants and the average number of female orthopaedic surgery faculty members. RESULTS A total of 101 U.S. medical schools were included in the final analysis. During the period examined, women accounted for 48.7% of medical school graduates, 14.9% of orthopaedic surgery applicants, and 13.2% of full-time orthopaedic surgery faculty. The percentage of female residency applicants increased from 13.91% in 2005 to 2006 to 16.02% in 2013 to 2014 while the percentage of female faculty increased from 12.26% in 2005 to 2006 to 15.79% in 2013 to 2014. No correlation was found between the average number of female orthopaedic surgery faculty at an institution and the total number of female orthopaedic surgery applicants from that institution during the study period examined (Rho, 0.0176; P = 0.5957). CONCLUSIONS The data presented in this study failed to demonstrate a relationship between the number of female faculty and the number of women who apply into orthopaedic surgery, which highlights the complex nature of this issue. More research is needed to examine factors influencing the recruitment of female medical students.
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Bucknor A, Christensen J, Kamali P, Egeler S, van Veldhuisen C, Rakhorst H, Mathijssen I, Lin SJ, Furnas H. Crowdsourcing Public Perceptions of Plastic Surgeons: Is There a Gender Bias? PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2018; 6:e1728. [PMID: 29876174 PMCID: PMC5977962 DOI: 10.1097/gox.0000000000001728] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Accepted: 01/30/2018] [Indexed: 11/26/2022]
Abstract
BACKGROUND Implicit gender bias may result in lower wages for women, fewer leadership positions, and lower perceived competence. Understanding public and patient gender preferences for plastic surgeons may enable opportunities to address public perceptions. This investigation evaluates public preferences for a plastic surgeon's gender or demeanor. METHODS Members of the Amazon Mechanical Turk crowdsourcing platform read 1 of the 8 randomly assigned scenarios describing a hypothetical situation requiring a plastic surgeon to operate on their mother. The scenarios differed only by surgeon gender, surgeon demeanor ("agentic," traditionally more masculine versus "communal," traditionally more feminine), or type of surgery. Using a Likert scale, respondents indicated their agreement with 7 statements on surgeon competence, skills, leadership qualities, likeability, respect, trustworthiness, and, ultimately, preference as a surgeon. Independent t tests were used to compare scores. Lower scores indicated a more negative response. RESULTS Overall, 341 responses were received: 55.7% were male and 45.5% white. There were no significant differences in any of the 7 characteristics assessed when examining by surgeon gender, only. However, female surgeons with a communal demeanor were perceived as less competent (4.32 versus 4.51, P = 0.018) and less skilled (4.36 versus 4.56, P = 0.019) than agentic female surgeons. Male respondents rated female surgeons lower than male surgeons in terms of competence (P = 0.018), skills (P = 0.034), likeability (P = 0.042), and preferred choice as a surgeon (P = 0.033). CONCLUSIONS Women plastic surgeons' demeanor and respondent gender affected perception of certain characteristics. Women plastic surgeons may consider ways to engage with the public to address possible gender role stereotypes.
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Affiliation(s)
- Alexandra Bucknor
- From the Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Mass
| | - Joani Christensen
- From the Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Mass
| | - Parisa Kamali
- Division of Plastic, Reconstructive and Hand Surgery, Radboud University, Nijmegen Medical Center, Nijmegen, The Netherlands
| | - Sabine Egeler
- From the Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Mass
| | - Charlotte van Veldhuisen
- From the Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Mass
| | - Hinne Rakhorst
- Division of Plastic and Reconstructive Surgery, Medisch Spectrum Twente, Enschede, The Netherlands
| | - Irene Mathijssen
- Department of Plastic and Reconstructive Surgery, Erasmus University, Rotterdam, The Netherlands
| | - Samuel J. Lin
- From the Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Mass
| | - Heather Furnas
- Department of Plastic and Reconstructive Surgery, Stanford University, Santa Rosa, Calif
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Abstract
BACKGROUND Sex parity of medical students has increased to the degree that approximately 50 % of medical students are women. Orthopedic and trauma surgery, however, has not managed to keep up with this trend and women are still grossly underrepresented. OBJECTIVES Description of an innovative longitudinal gender-based surgical and clinical skills training course. METHODS An elective 5-day modular skills course is offered for third to fifth year medical students. Module 1 aims at teaching basic surgical and communication skills involving local and regional anesthesia, initial experience with arthroscopy, fracture fixation, emergency measures as well as communication skills training using standardized patients. The subsequent modules cover surgical knowledge and skills of increasing complexity. The main goals are to increase the interest in orthopedic trauma surgery and to reduce concerns regarding discrimination and gender-related issues. Learning outcomes are assessed using a 6-item multiple choice questionnaire (MCQ) and a 3-stage objective structured clinical examination (OSCE) regarding induction of anesthesia, arthroscopy simulation and communication skills. RESULTS A total of 52 second year medical students (39 females, 13 males) completed module I. There were no differences between men and women with regard to the MCQ and anesthesia and communication skills; however, male students scored significantly higher in the arthroscopy test. All students rated the course as being highly effective in terms of acquisition of knowledge and skills. Almost all participants would recommend the course to fellow students and 70 % of participants stated they would participate in the advanced courses. Female participants in particular reported a marked increase in interest in orthopedic trauma surgery and less concerns regarding discrimination and gender-related issues. CONCLUSION The effectiveness of the approach will have to be proven by further evaluation, especially with respect to assessment of career development and application rates of participants. Adaptation of environmental and working conditions to suit women's needs seem to play an important role in promoting new surgery residents.
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Abstract
BACKGROUND Orthopaedic surgery now has the lowest percentage of women in residency programs of any surgical specialty. Understanding factors, particularly those related to the medical school experience, that contribute to the specialty's inability to draw from the best women students is crucial to improving diversity in the profession. QUESTIONS/PURPOSES (1) Does required medical school exposure to orthopaedic surgery increase the proportion of women choosing the specialty? (2) Do negative perceptions deter women from choosing orthopaedic surgery? (3) What proportion of orthopaedic faculty members are women, and what proportion of residents are women? (4) To what degree has gender bias been identified in the application/interview process? METHODS Two PubMed searches of articles between 2005 and 2015 were performed using a combination of medical subject headings. The first search combined "Orthopaedics" with "Physicians, women" and phrases "women surgeons" or "female surgeons" and the second combined "Orthopedics" with "Internship & Residency" or "exp Education, Medical" and "Sex Ratio" or "Sex Factors", resulting in 46 publications of which all abstracts were reviewed resulting in 11 manuscripts that were related to the research questions. The Google Scholar search of "women in orthopaedic surgery" identified one additional publication. These 12 manuscripts were read and bibliographies of each reviewed with two additional publications identified and included. RESULTS Required exposure to orthopaedics was found to be positively associated with the number of women applicants to the field, whereas negative perceptions have been reported to deter women from choosing orthopaedic surgery. Orthopaedics has the lowest percentage of women faculty and women residents (14%) compared with other specialties; this suggests that same gender mentorship opportunities are limited. For women applying to orthopaedics, gender bias is most evident through illegal interview questions, in which women are asked such questions more often than men (such as family planning questions, asked to 61% of women versus 8% of men). CONCLUSIONS Successful recruitment of women to orthopaedic surgery may be improved by early exposure and access to role models, both of which will help women students' perceptions of their role in field of orthopaedic surgery.
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Martinez M, Lopez S, Beebe K. Gender Comparison of Scholarly Production in the Musculoskeletal Tumor Society Using the Hirsch Index. JOURNAL OF SURGICAL EDUCATION 2015; 72:1172-1178. [PMID: 26232946 DOI: 10.1016/j.jsurg.2015.06.020] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/26/2015] [Accepted: 06/29/2015] [Indexed: 06/04/2023]
Abstract
OBJECTIVE Despite an increase in the proportion of female medical school graduates, the number of women in orthopedic surgery remains low. To examine the presence of gender disparities in scholarly production, the authors used the Hirsch index (h-index) to assess members of the Musculoskeletal Tumor Society (MSTS), a well-defined subspecialty of orthopedic surgery. DESIGN Using the MSTS Membership Directory, the authors assessed those practicing at an academic institution in the United States. Members׳ sex and rank was obtained from their department's website, and their h-index and years since initial publication was collected from the Scopus database. SETTING Research was performed at New Jersey Medical School, an institution, using online databases. PARTICIPANTS A total of 247 members of the MSTS were eligible, of whom 125 practiced at a US academic medical center and were included in the study. RESULTS The MSTS is composed of 247 members, 28 (11%) of whom are women. Within US academic medical centers, there are 125 members, including 17 (14%) women. Mean h-indices increased with rising academic rank from 5.42 for assistant professors to 19.28 for professors. Publication ranges showed an increase from 11.03 years for assistant professors to 29.52 years for professors. The h-index and publication years of chairpersons were nearly equal to those of professors. Using the h-index, it was found that men outproduce women-13.4:7.9. Men outnumber women at every rank, increasingly so at higher ranks. The authors found that there was a significant difference in productivity between ranks (p < 0.01) and between sexes (p = 0.035), but not between sexes at the assistant professor, associate professor, or professor levels (p = 0.147, 0.581, and 0.263, respectively). CONCLUSIONS The h-index shows differing production among the sexes and ranks in the MSTS. No significant difference exists between the sexes when members are organized by academic title.
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Affiliation(s)
- Maximilian Martinez
- Department of Orthopaedic Surgery, Rutgers-New Jersey Medical School, Newark, New Jersey.
| | - Santiago Lopez
- Department of Orthopaedic Surgery, Rutgers-New Jersey Medical School, Newark, New Jersey
| | - Kathleen Beebe
- Department of Orthopaedic Surgery, Rutgers-New Jersey Medical School, Newark, New Jersey
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Yahanda AT, Lafaro KJ, Spolverato G, Pawlik TM. A Systematic Review of the Factors that Patients Use to Choose their Surgeon. World J Surg 2015; 40:45-55. [DOI: 10.1007/s00268-015-3246-7] [Citation(s) in RCA: 67] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Yu TC, Jain A, Chakraborty M, Wilson NC, Hill AG. Factors Influencing Intentions of Female Medical Students to Pursue a Surgical Career. J Am Coll Surg 2012; 215:878-89. [DOI: 10.1016/j.jamcollsurg.2012.08.018] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2012] [Revised: 07/23/2012] [Accepted: 08/21/2012] [Indexed: 10/27/2022]
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Uzoigwe CE, Middleton RG. Occupational radiation exposure and pregnancy in orthopaedics. ACTA ACUST UNITED AC 2012; 94:23-7. [DOI: 10.1302/0301-620x.94b1.27689] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Radiological imaging is necessary in a wide variety of trauma and elective orthopaedic operations. The evolving orthopaedic workforce includes an increasing number of pregnant workers. Current legislation in the United Kingdom, Europe and United States allows them to choose their degree of participation, if any, with fluoroscopic procedures. For those who wish to engage in radiation-prone procedures, specific regulations apply to limit the radiation dose to the pregnant worker and unborn child. This paper considers those aspects of radiation protection, the potential effects of exposure to radiation in pregnancy and the dose of radiation from common orthopaedic procedures, which are important for safe clinical practice.
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Affiliation(s)
- C. E. Uzoigwe
- Leicester Royal Infirmary, Infirmary
Square, Leicester
LE1 5WW, UK
| | - R. G. Middleton
- Cheltenham General Hospital, Sandford
Road, Cheltenham, Gloucestershire
GL53 7AN, UK
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Baldwin K, Namdari S, Bowers A, Keenan MA, Levin LS, Ahn J. Factors affecting interest in orthopedics among female medical students: a prospective analysis. Orthopedics 2011; 34:e919-32. [PMID: 22146211 DOI: 10.3928/01477447-20111021-17] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The field of orthopedics has a limited ability to recruit high-quality female applicants. The purpose of this study was to determine whether early exposure to the field affects a woman's decision to pursue orthopedics. We performed a prospective, nonrandomized cohort study between academic years 2005 and 2009 and compared interest in orthopedic surgery among female (n=271) and male (n=71) medical students at 2 urban teaching institutions. Elective lectures and orthopedic literature were distributed via e-mail to the study participants. These materials included articles published in the medical literature, materials produced and distributed by the American Academy of Orthopaedic Surgeons, and Web sites providing educational materials. The primary outcome was the likelihood of application for orthopedic residency. We studied the influence of demographics, exposure, and attitudes on interest in pursuing an orthopedic career. Men had a significantly higher baseline level of interest in orthopedic surgery than women (P=.005). Younger age (P<.001) and personal (P<.001), independent (P<.001), and school (P=.023) exposures to orthopedics were significantly related to interest among women. At final follow-up, total personal exposures (P=.003) and total independent exposures (P<.001) in the form of our literature and lectures were correlated with final interest in women. Female interest was decreased by the long hours, physical demands, and predominantly male nature of the field. Early exposure to orthopedic educational resources may be useful in generating female interest. Perceptions and attitudes regarding orthopedic surgery must to be changed to attract the best and brightest minds, regardless of sex.
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Affiliation(s)
- Keith Baldwin
- Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
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31
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[How to become a trauma surgeon: analysis of the current situation and concepts for career development in the new common field of orthopaedics and trauma surgery--part II]. Unfallchirurg 2010; 113:598-605. [PMID: 20535441 DOI: 10.1007/s00113-010-1794-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
An increasing lack of young fellowship trainees in operative medicine, particularly in orthopaedics and traumatology and the various options to counteract this problem during the phases until the individual decision for residency and the fellowship program is made, were the focus of part I. The present part concentrates on residency and the fellowship phase including the individual perspectives after successful training. With respect to an attractive and highly qualified training in orthopaedics and traumatology, three essential points are to be made: a timely general framework, the establishment of a clinic-specific management of training and a general evaluation of training in the sense of a benchmarking system. A flexible work schedule including structural entities, such as an in-hospital day care facility for children, a structured and reliable curriculum of training according to a model curriculum to be adapted to the corresponding training unit including options of rotation to other facilities of training and the integration of nationwide education and mentoring programs represent further elements of an attractive training program. Thus the quality of training will become a decisive criterion of selection. The fellowship program for specialized traumatology inevitably leads to limitations of the whole spectrum of the field with an increasing specialization. In the future the contents of fellowship training will need a well-considered adaptation to the clinical needs and realities in the light of the emerging national trauma network program. A wide field of activity will open up to specialists in orthopaedics and traumatology with a focus on special traumatology considering the rapid changing field of hospital and outpatient care. Thus a systematic and creative reorganization of the residency and fellowship phases will overcome any problem of attractiveness.
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Mittlmeier T, Bonnaire F, Grützner PA, Lill H, Matthes G, Prokop A, Seifert J, Voigt C, Walcher F, Wölfl C, Siebert H. [How to become a trauma surgeon: analysis of the current situation and concepts for career development in the new common field of orthopaedics and trauma surgery--part I]. Unfallchirurg 2010; 113:504-12. [PMID: 20512307 DOI: 10.1007/s00113-010-1793-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The lack of clinical residents especially in the surgical domains, including orthopaedics and trauma surgery, is not only omnipresent but also a topic of lively discussions. This lack originates from sociopolitical and healthcare policy issues as well as from a loss of attractiveness of all surgical disciplines. The loss is caused by the high workload and disadvantageous working hours especially in those disciplines with a high rate of emergencies, e.g. trauma surgery. Moreover, it is caused by the poorly structured and unpredictable period of residency. In order to anticipate the bottleneck in supply due to the lack of trainees, a number of structural and contextual measures have to be taken to improve both undergraduate und postgraduate surgical training. Due to the numerous facets of the topic the first part of this analysis refers to the period until the trainee decides on the field of training.A basic insight into the field of orthopaedics and trauma surgery can already be offered far before the period of medical studies itself. During undergraduate medical education the existing structures should be modified, the characteristics of the discipline should be emphasized and the charm of combining theory and practical skills should be highlighted in order to enhance student's perception of the discipline. This might begin during preclinical training and should be continued throughout clinical training and elective courses (basic wound care, TEAM approach, AO course for students and seminars for M.D. candidates). Contextual and structural improvements of the practical year are indispensable to arouse students' interest in our discipline. These options conjoined with the actual offers for students provided by our scientific society, such as guided tours during the annual congress, travelling grants and the recently inaugurated summer school, might provide the basis for clearly structured information and offer a distinct stimulus to apply for residency in our field.
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Affiliation(s)
- T Mittlmeier
- Abt. für Unfall- und Wiederherstellungschirurgie, Chirurgische Klinik und Poliklinik der Universität Rostock, Schillingallee 35, 18055, Rostock, Deutschland.
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