We have cracked the ceiling, but how long must we walk on broken glass? Addressing the pitfalls confronting women in surgery

Operative Autonomy in a Gender-Balanced Cohort of Surgical Trainees

BACKGROUND

Gender inequity continues to be a major focus of improvements within surgical education. Female trainees are fewer and experience reduced quality of surgical training. Prior studies have demonstrated that surgical autonomy for female trainees in a range of surgical disciplines is less than that of male trainees. As a unique example among Australasian specialty training boards, the New Zealand Board of Plastic and Reconstructive Surgery has boasted a gender-balanced cohort of surgical trainees since 2013. The authors sought to examine the effect of gender on surgical autonomy in a cohort of trainees where gender balance has been achieved.

METHODS

A retrospective cohort study was undertaken. Anonymized logbook data for New Zealand plastic surgery trainees were analyzed, for the study period, consisting of rotations from December of 2013 to June of 2020. Self-reported levels of trainee supervision were compared against gender. Outcomes were tested using multivariate analysis.

RESULTS

Thirty-eight trainees were included in the study (58% female), with a total of 81,178 cases recorded over the 6.5-year study period. No overall statistically significant difference in surgical autonomy was identified when analyzed by gender. Male and female trainees showed similar trends of increasing surgical autonomy throughout the course of surgical training.

CONCLUSIONS

In a cohort of surgical trainees that has reached gender balance, the negative impact of gender on surgical autonomy was not identified. These findings suggest that where women make up an equal proportion of trainees, the implicit gender bias within surgical training may be ameliorated.

Gender inequity in the medical profession: the women doctors in Spain (WOMEDS) study

BACKGROUND

The long-standing underrepresentation of women in leadership positions in medicine is well-known, but poorly documented globally. There is some evidence of the gender gap in academia, medical society leadership, or specific problems in some specialties. However, there are no investigations analyzing all medical specialties together and reporting the glass ceiling from a 360º perspective that includes positions in academia, research, professional organizations, and clinical activity. Additionally, the majority of studies have a US perspective, and we wonder if the perspective of a European country might be different. The WOmen in MEDicine in Spain (WOMEDS) project ( https://womeds.es ) aims to describe and characterize, in a systematic and detailed way, the gender bias in the medical profession in Spain in order to monitor its evolution over time and contribute to prioritizing gender policies.

METHODS

We retrieved data for the calendar years 2019-2021 from several sources and selected surveys. We built four groups of indicators to describe leadership positions in the medical profession: (i) leadership in healthcare according to specialty and region; (ii) leadership in scientific and professional bodies; (iii) academic career; and (iv) leadership in clinical research activity. As a summary measure, we reported the women ratios, calculated as the percentage of women in specific top positions divided by the percentage of women in the relevant population.

RESULTS

We found gender inequity in leadership positions in all four settings. During the observed period, only 27.6% of the heads of departments in hospitals were women compared to 61.1% of women in medical staff. Ten of the 46 medical societies grouped in the Spanish Federation of Medical Societies (FACME) (21.7%) had a women president at some point during the study period, and only 4 annual congresses had ratios of women speakers higher than 1. Women were over-represented in the lower positions and underrepresented in the top academic ones. Only 26% and 27%, respectively, of the heads of departments and deans were women. The applications for public funding for research projects are led by women only in 45% of the cases, and the budget granted to women in public calls was 24.3% lower than that of men.

CONCLUSION

In all the areas analyzed, the leadership positions are still mostly occupied by men despite the feminization of medicine in Spain. The severe gender inequity found calls for urgent interventions within a defined time horizon. Such measures must concern all levels, from national or regional regulation to changes in organizational culture or incentives in specific organizations.

The persistent publication glass ceiling: an analysis of gender authorship trends in ANZ Journal of Surgery

BACKGROUND

women historically have been underrepresented in the field of academic publishing. This study aims to analyse ANZJS gender authorship trends and compare this to the proportion of women in surgery in Australia/NZ using RACS demographic data to provide parity context.

METHODS

This is a bibliographic gender analysis of ANZJS publications from 2002 to 2021; articles were analysed using a web-based application classifying gender from names.

RESULTS

There were 7265 articles analysed. Gender was predicted for 87% (6303/7265) first-, 89% (5847/6439) last- and 98% (323/329) editorial first-authors. There were 1269/6303 (20%) women first-authors, this increased from 14% to 27% (p = 0.001) over time. Eleven percent (654/5847) of last-authors were women, this proportion remained unchanged (p = 0.09). Eleven (3%) editorials were first-authored by women, with 3/329 (1%) as solo-author.

CONCLUSION

Numbers of women authors remain low in ANZJS, although the percentage of women first-authors has increased over time. However, if being last-author serves as a measure of senior academic supervision, and, editorial authorship shows leadership in one's field, women authors in these positions, in ANZJS, represent a small minority.