Women in Surgery Events Alone do not Change Medical Student Perceptions of Gender Bias and Discrimination in Orthopaedic Surgery

DiffErential attainment and Factors AssoCiated with Training applications and Outcomes (DE FACTO) study: Trauma & Orthopaedic surgery in the UK

Aims

The aims of this study were to describe the demographic, socioeconomic, and educational factors associated with core surgical trainees (CSTs) who apply to and receive offers for higher surgical training (ST3) posts in Trauma & Orthopaedics (T&O).

Methods

Data collected by the UK Medical Education Database (UKMED) between 1 January 2014 and 31 December 2019 were used in this retrospective longitudinal cohort study comprising 1,960 CSTs eligible for ST3. The primary outcome measures were whether CSTs applied for a T&O ST3 post and if they were subsequently offered a post. A directed acyclic graph was used for detecting confounders and adjusting logistic regression models to calculate odds ratios (ORs), which assessed the association between the primary outcomes and relevant exposures of interest, including: age, sex, ethnicity, parental socioeconomic status (SES), domiciliary status, category of medical school, Situational Judgement Test (SJT) scores at medical school, and success in postgraduate examinations. This study followed STROBE guidelines.

Results

Compared to the overall cohort of CSTs, females were significantly less likely to apply to T&O (OR 0.37, 95% CI 0.30 to 0.46; n = 155/720 female vs n = 535/1,240 male; p < 0.001). CSTs who were not UK-domiciled prior to university were nearly twice as likely to apply to T&O (OR 1.99, 95% CI 1.39 to 2.85; n = 50/205 vs not UK-domiciled vs n = 585/1,580 UK-domiciled; p < 0.001). Age, ethnicity, SES, and medical school category were not associated with applying to T&O. Applicants who identified as 'black and minority ethnic' (BME) were significantly less likely to be offered a T&O ST3 post (OR 0.70, 95% CI 0.51 to 0.97; n = 165/265 BME vs n = 265/385 white; p = 0.034). Differences in age, sex, SES, medical school category, and SJT scores were not significantly associated with being offered a T&O ST3 post.

Conclusion

There is an evident disparity in sex between T&O applicants and an ethnic disparity between those who receive offers on their first attempt. Further high-quality, prospective research in the post-COVID-19 pandemic period is needed to improve equality, diversity, and inclusion in T&O training.

Gender diversity in the National Joint Registry

Aims

Our primary aim was to establish the proportion of female orthopaedic consultants who perform arthroplasty via cases submitted to the National Joint Registry (NJR), which covers England, Wales, Northern Ireland, the Isle of Man, and Guernsey. Secondary aims included comparing time since specialist registration, private practice participation, and number of hospitals worked in between male and female surgeons.

Methods

Publicly available data from the NJR was extracted on the types of arthroplasty performed by each surgeon, and the number of procedures of each type undertaken. Each surgeon was cross-referenced with the General Medical Council (GMC) website, using GMC number to extract surgeon demographic data. These included sex, region of practice, and dates of full and specialist registration.

Results

Of 2,895 surgeons contributing to the NJR in 2023, 102 (4%) were female. The highest proportions of female surgeons were among those who performed elbow (n = 25; 5%), shoulder (n = 24; 4%), and ankle (n = 8; 4%) arthroplasty. Hip (n = 66; 3%) and knee arthroplasty (n = 39; 2%) had the lowest female representation. Female surgeons had been practising for a median of 10.4 years since specialist registration compared to 13.7 years for males (p < 0.001). Northern Ireland was the region with the highest proportion of female arthroplasty surgeons (8%). A greater proportion of male surgeons worked in private practice (63% vs 24%; p < 0.001) and in multiple hospitals (74% vs 40%; p < 0.001).

Conclusion

Only 4% of surgeons currently contributing cases to the NJR are female, with the highest proportion performing elbow arthroplasty (5%). Female orthopaedic surgeons in the NJR are earlier in their careers than male surgeons, and are less involved in private practice. There is a wide geographical variation in the proportion of female arthroplasty surgeons.

Association of Socioeconomic Status, Sex, Racial, and Ethnic Identity With Sustained and Cultivated Careers in Surgery

OBJECTIVE

Examine the association between sex, race, ethnicity, and family income, and the intersectionality between these identities, and sustained or cultivated paths in surgery in medical school.

METHODS

This retrospective cohort study examines US medical students who matriculated in academic years 2014-2015 and 2015-2016. Data were provided by the Association of American Medical Colleges, including self-reported sex, race, ethnicity, family income, interest in surgery at matriculation, and successful placement into a surgical residency at graduation. This study examined 2 outcomes: (1) sustained path in surgery between matriculation and graduation for students who entered medical school with an interest in surgery and (2) cultivated path in surgery for students who entered medical school not initially interested in surgery and who applied to and were successfully placed into a surgical residency at graduation.

RESULTS

Among the 5074 students who reported interest in surgery at matriculation, 2108 (41.5%) had sustained path in surgery. Compared to male students, female students were significantly less likely to have sustained path in surgery [adjusted relative risk (aRR): 0.92 (0.85-0.98)], while Asian (aRR: 0.82, 95% CI: 0.74-0.91), Hispanic (aRR: 0.70, 95% CI: 0.59-0.83), and low-income (aRR: 0.85, 95% CI: 0.78-0.92) students were less likely to have a sustained path in surgery compared to their peers. Among the 17,586 students who reported an initial interest in a nonsurgical specialty, 1869 (10.6%) were placed into a surgical residency at graduation. Female students, regardless of race/ethnic identity and income, were significantly less likely to have cultivated paths in surgery compared to male students, with underrepresented in medicine female students reporting the lowest rates.

CONCLUSIONS AND RELEVANCE

This study demonstrates the significant disparity in sustained and cultivated paths in surgery during undergraduate medical education. Innovative transformation of the surgical learning environment to promote surgical identity development and belonging for females, underrepresented in medicine, and low-income students is essential to diversify the surgical workforce.

The Ideal Orthopaedic Surgeon: Comparing Patient Preferences of Surgeon Attributes to Notions Held by Orthopaedic Postgraduates

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.

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSIONS

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