Workplace mistreatment and mental health in female surgeons in Pakistan

Unveiling pathways; the experiences that impact a female surgeon's journey to consultancy, a qualitative interview study

BACKGROUND

Despite progress in gender equality, female surgeons face unique career challenges. This dissertation explores the factors influencing female surgeons' careers, with the aim of identifying female surgeons' positive experiences, but also the obstacles they encounter, and the strategies they use to overcome challenges.

METHODS

A qualitative research methodology was employed to understand the experiences of female surgeons working at a single healthcare facility in Western Australia. An interpretivist approach guided the study, focusing on the subjective experiences and perceptions of the participants. Data was collected through semi-structured interviews with female consultant surgeons. Braun and Clark's thematic analysis was used to identify and interpret key themes within the interview data.

RESULTS

Some surgeons struggled with a lack of female mentorship. Participants experienced various forms of sexism, ranging from subtle biases to overt discrimination. Supportive family structures and effective time management are crucial for balancing professional and personal demands. Resilience and determination were essential for success. While some felt pressured to adopt traditionally masculine traits, others found value in maintaining traditionally feminine qualities, emphasizing the importance of authenticity.

CONCLUSION

Barriers persist for female surgeons, including subtle discrimination, challenges related to motherhood, and pressure to conform to male stereotypes. Although overt harassment is less common, subtle forms can still affect one's mental health and career progression. In order to foster a more inclusive environment for women, continued efforts are needed to address these challenges and enhance support for female surgeons.

Workplace sexual harassment and violence among women: a systematic review and meta-analysis

The objective of the current systematic review and meta analysis was to assess workplace sexual violence among women, aiming to provide a comprehensive understanding of the issue's magnitude and implications across various professional sectors and geographical locations. A systematic search of six electronic databases was conducted following PRISMA guidelines, including studies published up to April 15, 2023. The JBI Critical Appraisal Tool was used for quality assessment, and a random-effects model calculated the pooled prevalence. Heterogeneity was assessed using I² statistics, with outliers identified through diagnostic and Baujat plots, followed by a leave-one-out meta-analysis. Publication bias was examined using the Doi plot and LFK index, and subgroup analyses explored variations in geographical location, occupational domain, and time period. A total of 912 studies were screened, with 129 meeting inclusion criteria, comprising 333,649 female participants. The pooled prevalence of workplace sexual violence was 26 percent (95 percent CI: 1-32 percent), with substantial variability observed across regions and occupational groups; prevalence was highest in Africa (38 percent, 95 percent CI: 29-47 percent), followed by North America (34 percent, 95 percent CI: 25-43 percent), and Asia (30 percent, 95 percent CI: 17-47 percent). Among occupational groups, security personnel experienced the highest prevalence (44 percent, 95 percent CI: 22-68 percent), while health-care workers were also highly affected (30 percent, 95 percent CI: 24-38 percent). Workplace sexual violence remains a global issue, affecting over a quarter of female workers, with its prevalence influenced by cultural, occupational, and temporal factors. These findings underscore the necessity for tailored interventions, comprehensive workplace policies, and supportive reporting mechanisms, while ongoing monitoring and evidence-based strategies are essential to mitigate risks, protect employees, and foster safer workplace environments worldwide.

A questionnaire on the perception of social and academic discrimination against female general surgeons in Türkiye

Objective

The purpose of this research was to identify the specific prejudices that women in general surgery in Türkiye have to face in their workplace and academic careers. This was achieved by gathering the opinions of both genders on these issues and raising awareness of gender bias to promote a more inclusive environment for future generations of surgeons.

Material and Methods

A total of 202 people, 99 male and 103 female surgeons, participated in the survey. The questionnaire was distributed to people working in general surgery clinics via e-mail and WhatsApp groups of the Turkish Surgical Association and the Turkish Colorectal Association.

Results

The mean age of the participants was 37.65±11.55 years (ranging from 24 to 74 years). Among the partipiciants, 40.4% agreed that surgery is more suitable for males, while 89.3% of women disagreed (p<0.001). 88.3% of the women stated that women are negatively influenced in choosing general surgery because of the male-dominated environment, and 52.5% of men agreed, while 40.4% of men disagreed (p<0.001). 66.7% of men and 65% of women believed that women do not prefer to work in general surgery because it is difficult to balance with family responsibilities (p=0.890). Women are more subjected to humiliating behaviors, while 53.4% of women agree. 85.4% of the women stated that it is important to have a female lecturer as a role model in the institution where they work.

Conclusion

This study shows different views on gender prejudice among male and female surgeons in general surgery. Female respondents, including male and female surgeons, indicated experiencing bias and underrepresentation in academic disciplines, although they had differing perspectives on discrimination. Both genders agreed on the difficulty of work-life balance, with a similar percentage of individuals identifying family responsibilities as an obstacle.

Editorial diversity correlates with journal impact factor and author diversity in cardiothoracic surgery

INTRODUCTION

While there are no widely accepted diversity, equity, and inclusion (DEI) metrics for journals, geographic and sex diversity across a journal's editorial board may provide a surrogate measure of its commitment to DEI. We explored the association between journal quality and DEI metrics for cardiothoracic surgery (CTS) journals and investigated whether editorial diversity correlates with diversity across published articles.

METHODS

We collected the following data for 30 CTS journals: country of publication (categorized by income level), journal quality metrics (citation-based metrics, e.g., impact factor (IF) or H-index), and sex and geographic representation across editorial boards and published articles. Bivariate correlations between numeric variables were assessed using Spearman's correlation.

RESULTS

Female representation across editorial boards was 12.1%. Most editorial board members belonged to the United States (35.2%), with only 7.4% from the lower-middle-income countries and 0% from low-income countries. IF showed a strong positive correlation with female editorial representation (r = 0.70) but an inverse correlation with low- and middle-income countries (LMICs) editorial representation (r = -0.45). Female editorial representation demonstrated a significant positive correlation with female first authorship (r = 0.45), whereas LMIC editorial representation correlated strongly with LMIC corresponding authorship (r = 0.85).

CONCLUSION

Women and researchers from LMICs are in the minority across editorial boards of CTS journals. However, a strong correlation between journal H-index and female editorial representation indicates that top-ranked journals are spearheading efforts to improve equitable sex-based and gender representations. Similar efforts are required to ensure more global geographic representation across editorial boards and top-ranked CTS journals are the best placed to lead by example.

Sex differences in altmetric attention scores and traditional impact metrics of top-cited general surgery literature: Cracks in the ceiling?

BACKGROUND

Sex disparities have previously been identified in surgical academia. This study examines sex differences in the top-cited contemporary general surgery articles and compares Altimetric Attention Score (AAS) and other impact metrics between male and female corresponding authors (CAs).

METHODS

We conducted a bibliometric analysis of the 100 most cited articles published between 2019 and 2021 in each of the top 10 general surgery journals based on the 2021 Journal Impact Factor. Impact metrics included AAS, citation count, and H-index of the CA. We used multivariable regression analyses to investigate whether the sex of the CA or first author (FA) was independently associated with AAS and citation count.

RESULTS

Among 1000 articles, 23.1% had female CAs and 27.4% female FAs. Female CA articles had higher AAS (13.0 [2.0-63.0] vs. 8.0 [1.0-28.5]; p < 0.001) and lower H-indices (24.0 [11.0-45.0] vs. 31.0 [17.0-50.0]; p = 0.015). Although median citation count did not differ by CA sex, articles with Level 1 evidence and a female CA were cited more often (35.5 [24.0-85.0] vs. 25.0 [16.0 vs. 46.0]; p < 0.05). In multivariable regression, female CA articles had higher AAS (OR: 1.002 [95% CI: 1.001-1.004]) and lower H-index (OR: 0.987 [95% CI: 0.977-0.997]).

CONCLUSION

Despite having similar citation counts, articles authored by female CAs exhibit higher AAS scores compared to those authored by their male counterparts. While it is heartening that research authored by female surgeons achieves significant visibility, it remains to be understood how this translates into academic impact and scholarly recognition.

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

PURPOSE

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

LEVEL OF EVIDENCE

IV.

Women physicians, their social issues & Barriers to their success in Academic Medicine

doi: https://doi.org/10.12669/pjms.38.8.7047 How to cite this:Jawaid SA. Women physicians, their social issues & Barriers to their success in Academic Medicine. Pak J Med Sci. 2022;38(8):2049-2052. doi: https://doi.org/10.12669/pjms.38.8.7047 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Systematic Review of Policies and Interventions to Prevent Sexual Harassment in the Workplace in Order to Prevent Depression

BACKGROUND

Sexual harassment in the workplace (SHWP) is highly prevalent and has a negative impact, including depression, on its victims, as well as a negative economic impact resulting from absenteeism and low productivity at work. This paper aims to outline the available evidence regarding the prevention of depressive symptoms among workers through policies and interventions that are effective in preventing SHWP.

METHODS

We conducted two systematic reviews. The first focused on the association of depression and SHWP, and the second on policies and interventions to prevent SHWP. We conducted a meta-analysis and a narrative synthesis, respectively. We identified 1831 and 6107 articles for the first and second review. After screening, 24 and 16 articles were included, respectively.

RESULTS

Meta-analysis results show a prevalence of depression of 26%, as well as a 2.69 increased risk of depression among workers who experience SHWP. Variables such as number of harassment experiences and exposure to harassment from coworkers and other people increase this risk.

CONCLUSIONS

There is limited evidence regarding the effectiveness of policies and training to prevent SHWP, mostly focused on improvements in workers' knowledge and attitudes about SHWP. However, there is no available evidence regarding its potential impact on preventing depression.

Harassment in surgery: line in the sand

Over the last few years, the #MeToo movement has brought attention to the long-standing culture of abuse in hierarchical organisations, and surgery is no exception. Harassment and abuse of any form should cease to be tolerated. This moment needs to be a line in the sand, the stimulus for change in our community and wider society.

Factors Influencing the Intention to Pursue Surgery among Female Pre-Medical Students: A Cross-Sectional Study in Pakistan

BACKGROUND

While gender disparities in surgery are documented worldwide, it is unclear to what extent women consider surgery as a career before embarking on their medical school journey. This study aimed to report the percentage of pre-medical women in Pakistan who intend to eventually specialize in surgery and assess the factors motivating and deterring this decision.

METHODS

An online survey was conducted among female pre-medical (high school) students across Pakistan. Multivariable logistic regression was performed to determine motivating and deterring factors associated with the intention to pursue surgery.

RESULTS

Out of 1219 female high-school students, 764 (62.7) intended to join medical school. Among these 764, only 9.8% reported an exclusive intent to pursue surgery, while just 20.3% reported considering other specialties in addition to surgery. Significant motivators to pursue surgery exclusively were the intellectual satisfaction of pursuing surgery (adjusted odds ratio: 2.302), having opportunities to travel internationally for work (2.300) and use cutting-edge technology (2.203), interest in the specialty of surgery (2.031), the social prestige of becoming a surgeon (1.910), and considering one's personality well-suited to surgery (1.888). Major deterrents included the lack of interest in surgery (adjusted odds ratio: 3.812), surgical education and training being too difficult (2.440) and lengthy (1.404), and the risk of aggressive behavior from patients (2.239).

CONCLUSION

Even before entering medical school, most female pre-medical students have already decided against considering a future surgical career. Deterrents likely stem from women being pressured to conform to deep-seated societal expectations to dedicate their time and energy to domestic responsibilities.