A Gravid Situation: General Surgery Faculty Support for Pregnant Surgical Residents.

INTRODUCTION: The perceptions of teaching faculty toward pregnant general surgery residents have been overlooked despite the daily interactions amongst these groups. METHODS: A 32-question survey designed to measure general surgery teaching faculty perceptions toward pregnant residents was distributed electronically from March 2022 to April 2022 to general surgery teaching faculty in the United States. Descriptive statistics were used to characterize responses and differences in perceptions, and qualitative analysis identified recurring themes from free-text responses. RESULTS: Among 163 respondents included in the final analysis, 58.5% were male and 41.5% were female. Despite 99.4% of surgeons feeling comfortable if a resident told them they were pregnant, 22.4% of surgeons disagreed that their institutions have supportive cultures toward pregnancy. Almost half (45.4%) have witnessed negative comments about pregnant residents and half (50.3%) believe that pregnant surgical residents are discriminated against by their coresidents. Nearly two-thirds of surgeons (64.8%) believe that someone should have a child whenever they wish during training. Given recent reports, 80.2% of surgeons recognized that female surgeons have increased risks of infertility and pregnancy complications. Recurring themes of normalizing pregnancy, improving policies, and creating a culture change were expressed. CONCLUSIONS: In this national survey, although there appears to be positive perceptions of pregnancy in surgical training amongst those surveyed, there is acknowledged necessity of further normalizing pregnancy and improving policies to better support pregnant residents. These data provide further evidence that though perceptions may be improving, changes are still needed to better support pregnancy during training.

Androcentric bias in surgical equipment - What challenges do women face?

BACKGROUND: Increasing diversity amongst surgeons results in a wide range of sizes and strengths. There are many types of biases affecting women surgeons. This study evaluates what challenges women surgeons may have with surgical equipment. METHODS: An online survey was distributed to Women in Surgery social media groups in North America and Australasia between April 2022-July 2022. RESULTS: There were 480 respondents across the range of specialties. 453 surgeons were included. Median glove size was 6.5. Difficulty with use of surgical instruments due to size was reported by 89% of surgeons and 71% reported difficulty due to the required grip strength. One hundred and twelve different tools were reported to be problematic. CONCLUSIONS: This study highlights a potential source of androcentric bias which could be addressed to improve equity for women surgeons.

Gender bias in colorectal surgery fellowship letters of recommendation.

BACKGROUND: As leaders strive to create equitable surgical pipelines, one process under scrutiny is letters of recommendation (LORs). We sought to review the Colon and Rectal Surgery (CRS) Resident Candidate Assessment questionnaire and LORs for gendered differences. METHODS: This retrospective observational study of letters of recommendation to CRS fellowship during the 2018-2019 application cycle utilized linguistic Inquiry and Word Count (LIWC2015) software to assess letter length and themes comparing differences by applicant and referee gender. RESULTS: 103 applicants (35 â€‹% women) with 363 LORs (16 â€‹% written by women) were included. Short answer responses were longer for women applicants, while LORs were longer for men applicants (368 vs 325 words p â€‹= â€‹0.03). Men applicants' strengths had more technical skill descriptors, while women applicants' strengths had more emotional language and cognitive and perceptual words. CONCLUSIONS: This study found significant differences between LORs written for CRS fellowship applicants based on gender.

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

BACKGROUND: Career satisfaction among women surgeons have been well-reported in literature. This study provides a comprehensive review to understand career satisfaction and its contributory factors among female surgeons. METHODS: PRISMA guidelines were utilized to extract studies for systematic review and meta-analysis. Outcomes assessed included surgical career satisfaction, career reconsideration, work-life balance, and gender bias and discrimination (GBD). Odds ratios were calculated comparing women to men for each outcome. RESULTS: This study demonstrated that female surgeons were less likely to endorse overall career satisfaction (OR, 0.68; 95% CI, 0.55-0.85) and work-life balance satisfaction (OR, 0.61; 95% CI, 0.40-0.92) compared to male surgeons. It also revealed that women surgeons were more likely to report workplace GBD (OR, 13.82; 95% CI, 4.37-43.65). CONCLUSIONS: Future interventions may be necessary to increase career and work-life balance satisfaction among women surgeons while reconciling the need to ensure they are adequately informed of the obligations of a surgical career.

Fertility and Pregnancy: How Do These Affect Family Planning and Surgeon Health?

There are unique considerations to fertility and pregnancy for women surgeons. Women surgeons often decide to delay pregnancy and childbearing due to concerns of conflict with work and training. This is particularly true for surgical trainees who face many obstacles, including bias from peers and program directors, and work-life conflict. As such, rates of infertility are higher compared with the general population. Women surgeons require assisted reproductive technologies more often than the general population. During pregnancy, there are also additional occupational hazards that are unique to a surgical career. Overall, we must be aware of these issues to support surgeons who decide to become parents during a surgical career.

Representation of women in orthopaedic surgery: perception of barriers among undergraduate medical students in Saudi Arabia.

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.

Exploring the Influence of Gender on Surgical Clerkship Grades and Test Scores: A Single Institution, Multisite Comparison.

OBJECTIVE: General surgery remains a male-dominated specialty. Women constitute 54% of medical students at the University of Washington, but only 3.4% of full professors within the Department of Surgery. Many believe surgical attrition and "the leaky pipeline" starts during medical school clerkships, but the exact deterrents remain undefined. This study examined the impact of gender on grading during the third-year surgical clerkship. DESIGN: Retrospective analysis of confidential final clerkship grades, examination scores and subjective clerkship grades was conducted. These were compared by gender, time period, and type of clerkship site. Chi-square analyses were performed. SETTING: Clerkship sites across multiple academic (n = 6) and nonacademic (n = 14) locations. PARTICIPANTS: All third-year medical students undergoing a core surgical clerkship over 2 time periods-2007 to 2010 (period 1) and 2016 to 2019 (period 2)-were included. RESULTS: There were 539 medical students in period 1 and 792 in period 2. The percentage of women was stable over time (52.0% vs 54.2%, p = 0.43). Final clerkship grades of Honors increased significantly from period 1 to 2 (22.3% vs 44.3%, p < 0.0001) and was similarly distributed by gender (women: 21.4% vs 48.0%, p < 0.0001; men 23.2% vs 39.9%, p < 0.0001). Honors on examinations remained stable over time and did not differ by gender. Women earned more final clerkship honors than men at academic sites in period 2 (48.4% vs 30.9%, p < 0.001). This finding was not identified in period 1, nor at nonacademic sites. CONCLUSION: There was a significant increase in surgical clerkship honors over the past decade, independent of gender. Women attained more clinical and final clerkship honors than men and similar exam grades as time progressed, suggesting that gender bias in the subjective grading of women at this institution does not directly contribute to the loss of talented women as they progress from medical student to faculty within the department, with said gender imbalance not related to clerkship evaluations.

Gender Differences in Ophthalmic Procedural Volume: A Study of Male vs. Female Glaucoma Specialists.

PURPOSE: To investigate whether differences in procedural volume exist between practicing male and female glaucoma specialists. DESIGN: A cross-sectional analysis. SUBJECTS: A total of 213 female and 666 male glaucoma specialists who performed ≥ 11 traditional, incisional glaucoma procedures for Medicare beneficiaries between 2014 and 2018. METHODS: The 2014 to 2018 Medicare Provider Utilization and Payment Data database was queried using Current Procedural Terminology and Evaluation and Management codes to identify clinic visits and cataract, glaucoma drainage implant (GDI), trabeculectomy, minimally invasive glaucoma surgery (MIGS), and office-based glaucoma laser procedures. The number of procedures performed per provider was averaged and compared between genders. The univariate ordinary least squares linear regression analysis was used to investigate the effects of gender on procedural volume. The multivariate ordinary least squares linear regression analysis was used to examine the effects of gender, the number of group practice members, and the number of years after medical school graduation on cataract, GDI, trabeculectomy, MIGS, and glaucoma laser procedural volumes. MAIN OUTCOME MEASURES: Mean difference in the number of procedures by gender and predictors of procedural volume. RESULTS: In the univariate analysis, men performed an estimated 7.8 more MIGSs (95% confidence interval [CI], 2.7-12.9; P = 0.003), 138.9 more cataract procedures (95% CI, 59.6-218.3; P = 0.0006), and 1.99 more GDI procedures (95% CI, 0.03-3.95; P = 0.046) than women. This relationship remained true for MIGS and cataract procedures in the multivariate analysis after controlling for clinical volume, the number of group practice members, and the number of years after medical school graduation (MIGS, ß = 6.1 [95% CI, 0.5-11.8; P = 0.03]; cataract, ß = 110.2 [95% CI, 16.9-203.5; P = 0.02]). Glaucoma drainage implant procedures were no longer associated with the gender of the surgeon in the multivariate analysis (ß = 2.1, 95% CI, -0.1 to 4.2; P = 0.06). The volumes of trabeculectomy and office-based glaucoma laser procedures did not differ between the genders in both the univariate (glaucoma laser, ß = 7.0 [95% CI, -4.4 to 18.5; P = 0.23]; trabeculectomy, ß = 2.7 [95% CI, -0.8 to 6.2; P = 0.13]) and multivariate analyses (glaucoma laser, ß = -7.3 [95% CI, -18.7 to 4.1; P = 0.21]; trabeculectomy, ß = 1.7 [95% CI, -5.6 to 2.1; P = 0.38]). CONCLUSIONS: Women performed fewer MIGS and cataract procedures than men, even after controlling for clinical volume, the number of years after medical school graduation, and the number of group practice members. After controlling for these factors, there was no difference in the incisional glaucoma or glaucoma laser procedural volume between genders. Further research is needed to understand factors contributing to these differences.

The Perry Initiative's Impact on Gender Diversity Within Orthopedic Education.

PURPOSE OF REVIEW: Orthopedic surgery lags behind the other surgical specialties in terms of reaching gender equality, and women remain underrepresented in the field. The reason for this disparity is multifaceted, with lack of exposure and mentorship frequently cited as two key reasons women fail to choose orthopedic surgery as a specialty. Recognizing these gender differences, The Perry Initiative was founded to increase young women's exposure to the field, provide mentorship opportunities, and recruit women into orthopedic surgery and related engineering fields. The purpose of this article is to describe the measurable impact of The Perry Initiative on increasing the number of women matriculating into orthopedic residencies. RECENT FINDINGS: Though roughly half of medical school graduates today are women, only 16% of active orthopedic surgery residents are women. To date, The Perry Initiative has reached over 12,000 women in high school and medical school, and of the program participants who are eligible to match into any residency program, 20% matched into orthopedic surgery residencies. This indicates that the women who participated in Perry Initiative outreach programs are entering orthopedic surgery at a rate that is higher than the current rate of women entering orthopedic surgery. The model behind The Perry Initiative's outreach efforts can be scaled and expanded, ideally reaching more women and making progress towards closing the gender gap within orthopedic surgery and achieving greater gender diversity.

Women doctors in female urology: current status and implications for future workforce.

OBJECTIVE: To objectively determine the percentage of female trainees and consultants who are interested in their career being focussed on female urology (FU) in order to facilitate the improved planning for the future of this sub-specialty. SUBJECTS AND METHODS: This was an international cross-sectional study spanning 1 year, from December 2018 to December 2019. An anonymous, voluntary survey was generated using the online survey generator Survey monkey® . The survey was sent to urology consultants and trainees who were female from Australia, New Zealand, and Canada. RESULTS: The total response rate to the survey was 61%. Up to 50% of female consultants and trainees selected a career in FU due to their gender, but up to 75% of respondents were also interested in FU of their own accord. Common concerns held by a majority of respondents included both the medical community's and the public's lack of awareness of FU as a component of urological expertise. Despite these concerns, most of the trainees were not concerned regarding their future work opportunities in FU, and many had intentions to pursue a fellowship in FU. CONCLUSION: Female urology is an increasingly popular sub-specialisation of urology, given the steady increase in the intake of female trainees. Similar trends were identified internationally. Urology training in this area will need to continue to increase the community's and the primary health care referrer's awareness in order to ensure the continued success and growth of the sub-specialty.

Women in thoracic surgery: European perspectives.

During the last decades, women have been discouraged from entering the medical career and in particular in the surgical specialties. This situation is changing across continents and national and international initiatives are supporting aspiring female surgeons in pursuing the surgical career through mentorship and fellowship programmes. Due to the differences in training programmes, Health Care systems and cultural backgrounds, it's not easy to describe unanimously the pathways and obstacles that junior female thoracic surgeons are experiencing in Europe. The development of female surgical associations, mentorship programmes and national initiatives will further champion the gender equality in this specialty across Europe. During the recent years, the European Society of Thoracic Surgeons (ESTS) has established initiatives like the first ESTS Women in Thoracic Surgery Scientific Session or the annual Women in Thoracic ESTS Reception during the Annual Conference, which are done in an effort to encourage all female colleagues to join this specialty and increase the opportunity to share their experience and meet potential mentors. In this article we will depict the situation in some of the European countries whose female thoracic surgeons have led their way. We aim to give the next generation the examples that can influence women's choice of surgical career, and the possible strategies and initiatives to reduce the gender discrimination within healthcare.

Women in thoracic surgery: Asian perspective.

There is a significant shortage of surgeons in Japan similar to many other countries. There are 40,267 registered surgeons for Japan Surgical Society, among them 23,723 are board certificated, and 7,246 are certified instructors. A total of 3,207 surgeons are members of The Japanese Associations for Chest Surgery, and 245 (7.6%) are female surgeons. Approximately 8,000 medical students graduate annually with medical license. The number of newly registered residents and surgeons has recently been declining overall in the last two decades, however, the percentage of female physicians entering into surgery has been increasing gradually along with increasing number of female medical students entering the medical schools and colleges. With regard to the issue of gender gap, our country is ranked as low as 121 out of 153 countries according to global gender gap report 2020 by World Economic Forum, dropping down from 110 out of 149 countries from previous report in 2018. As the numbers of female colleagues in our workplace increases, we must consider what we can do to build a better working environment for them that is more inclusive and supports their career. In this review, the brief history of surgery and female surgeons is described as well as current situations of female surgeons today in Japan.

Women in thoracic surgery: lesson learned from medical industry partners.

Medical technology has led to important achievements in surgery as minimally invasive techniques have expanded over the past several years. These innovations have changed the dynamic between industry and surgeons towards a more collaboration relationship forming partnerships important to surgical advancement and technical training opportunities. On this backdrop of transformation is growing awareness of the gender disparity that exists within the thoracic surgery workforce where we have experienced strikingly little change. At the same time, medicine is not unique with its gender disparity. As we have benefited from important partnerships to create excellence in technical innovation, so too may we benefit from drawing upon some of the successes within the medical industry towards achieving gender equity. This paper highlights examples of female leaders in the medical industry surrounding thoracic surgery, who have demonstrated excellence in the advancement and promotion of female thoracic surgeons through fellowships, mentorships or networking.

How pregnancy and childbirth affect the working conditions and careers of women surgeons in Japan: findings of a nationwide survey conducted by the Japan Surgical Society.

PURPOSE: To identify the conflicts between a career as a surgeon and pregnancy and childbirth for women in Japan. METHODS: The Japan Surgical Society conducted a nationwide survey on pregnancy and childbirth among its members who are women. The questionnaire included items regarding demography, working styles, and pregnancy and childbirth, including adverse events and harassment. RESULTS: The response rate was 29.9% (1068 responses, median age, 37 years). Among the responders, 61% were married and 47% had children (average number of children, 1.7). Half of the respondents reported having experienced sexual harassment and 62% reported having received unwelcome comments about pregnancy. About 20% had undergone fertility treatment. In total, 51% had pregnancies, with miscarriages in 33% of these. The top answer for the best timing for pregnancy and childbirth was after becoming board-certified. Nearly one-third of first-time mothers experienced adverse events during pregnancy and delivery, and 28% quit or changed their job because of their pregnancy and the birth of their first child. CONCLUSIONS: Japanese women who choose a career as a surgeon face obstacles during pregnancy and childbirth. It is vital to share the findings of this study and understand the issues associated with pregnancy and childbirth regardless of gender. Interventions are essential to ensure that every pregnant surgeon has a safe working environment to allow unobstructed development of her career.

Does gender influence leadership roles in academic surgery in the United States of America? A cross-sectional study.

BACKGROUND: Gender disparity remains prevalent in the field of academic surgery with an under-representation of women at senior leadership ranks. A wide variety of causes are reported to contribute to this gender-based discrimination but a current quantitative analysis in the US has significant importance. This cross-sectional study aims to document gender disparity in academic and leadership positions in surgery as well as its relationship with scholarly productivity. MATERIAL AND METHODS: The American Medical Association's Fellowship and Residency Electronic Interactive Database (FREIDA), was used to identify General Surgery programs. Each institution's website was used to identify its faculty's primary profiles for data collection. Individuals with an MD or DO, and an academic ranking of Professor, Associate Professor or Assistant Professor were included. Academic productivity was quantified by recording H-index, number of publications, number of citations, and years of active research of a physician. All statistical analysis was performed on SPSS Statistics version 20.0. RESULTS: A total of 144 academic programs were including in our analysis constituting 4085 surgeons, only one-fifth (n = 873, 21%) of which were women. Furthermore, only 19% of all leadership positions were assumed by female surgeons. Leadership positions and academic rank correlated significantly with increasing research productivity. The difference in H-index between genders was statistically significant (P < 0.05) with men possessing a higher median for H-index [13] than women [9]. Transplantation Surgery [17] had the highest median H-indices for female surgeons. Male surgeons (n = 18) were twice as likely to be Departmental Chairs as their female counterparts (n = 9). However, female surgical oncologists held the highest proportion of leadership positions (31%). CONCLUSION: A significant gender-based disparity was found in leadership positions and academic ranks. Research productivity appeared to be integral for academic and leadership appointments. Institution-level measures that enhance support, mentorship, and sponsorship for women are imperative to achieve overall parity in general surgery.

The confidence gap: Findings for women in plastic surgery.

BACKGROUND: In a surgical field, where surgeons are, "sometimes wrong, but never in doubt," lack of confidence can have detrimental effects on career advancement. In other fields there is evidence that a gap exists between women and men in the amount of confidence they display, and that confidence is a proxy for success. METHODS: This study used the General Self Efficacy Scale and Rosenberg Self-Esteem Scale confidence surveys to assess self confidence amongst female trainees and attending plastic surgeons, to search for baseline characteristics associated with higher confidence scores. RESULTS: Of the 73 participants, protective factors associated with increased female plastic surgeon confidence include age, parity, more advanced academic status, and mentorship. CONCLUSIONS: In order to matriculate into a surgical training program, there must be a measure of confidence and resiliency, but further work needs to be done to identify and address gender gaps in training and early academic careers.

The Association of Women Surgeons research grant: An analysis of the first 25 years.

BACKGROUND: The impact of the Association of Women Surgeons (AWS) Research Grant on academic productivity is unknown. METHODS: Grant applications were obtained from AWS archives. Applicant bibliometrics and National Institutes of Health (NIH) grants were identified via public databases. RESULTS: Twenty-four recipients between 1996 and 2020 and 68 nonrecipients between 2012 and 2017 were identified. $596,700 was awarded over the 25 years. Twenty-five percent of recipients subsequently acquired NIH funding amounting to $6,611,927.00, an 885-1008% return on investment. Compared to nonrecipients, grant recipients produced a greater mean number of publications (50.6 versus 36.4; p = 0.05), had a higher h-index (15.92 versus 10.7; p = 0.01), and were cited in higher impact factor journals (6.32 versus 3.9; p = 0.02). CONCLUSIONS: Overall, previous AWS Research Grant recipients were more likely to become more impactful surgeon-scientists, as indicated by a higher post-award rate of NIH funding, total number of publications, and h-index than nonrecipients.

Men surgeons' perceptions of women surgeons: is there a bias against women in surgery?

BACKGROUND: Surgery has long been a man-dominated discipline with gender roles traditionally defined along societal norms. Presumably, as society has evolved, so have men surgeons' perceptions of women surgeons, though data are lacking. This study was undertaken to determine if men surgeons' perceptions of women surgeons represent a bias against women in Surgery. METHODS: 190 men surgeons were queried about attitudes toward women surgeons utilizing a validated questionnaire. The survey included binary, multiple choice, and Likert scale questions (1 = definitely disagree to 5 = definitely agree). RESULTS: 84% of the men surgeons have been attending surgeons for more than 5 years; 80% deem women surgeons as capable as their man colleagues. 80% of respondents consider it possible for a woman to be a good surgeon, mother, and spouse; however, 76% believe women surgeons experience more pressure to balance work and family. 75% of the men surgeons think women surgeons have the same advancement opportunities as men, though 30% believe gender discrimination exists in Surgery. 45% of the respondents consider the "surgical discipline" accountable for fewer women finishing training, yet 57% think the rate of women entering Surgery is not a problem to address. CONCLUSION: While most men surgeons have favorable opinions of the personal and professional abilities of women surgeons, favorable opinions are not universal; a bias against women persists in Surgery. Considering most medical students today are women, the discipline of Surgery dismisses this talent pool only to its detriment. Surgery, and men in Surgery specifically, must evolve to eliminate bias against women in Surgery, promoting an equitable and inclusive work environment for the betterment of Surgery and all its stakeholders, including patients.

Current conditions and issues of physicians and working conditions at institutions accredited by the Japanese Breast Cancer Society.

BACKGROUND: In Japan, with the rapid increase of breast cancer patients, there has been increasing demand for breast cancer treatment. As the main workforce for breast cancer treatment, women physicians are thought to be in key positions, since the number of women physicians has recently been increasing. METHODS: To clarify the current statuses and issues of physicians and work conditions at the accredited breast cancer care facilities, a survey was conducted by the Japanese Breast Cancer Society (JBCS). RESULTS: The main workforces engaged in breast cancer care are surgeons, and the number of breast surgeons of all institutions in this survey was 1338 (full time 1124, part time 214). The percentages of women among surgeons, breast specialists accredited by the JBCS, and residents are 22%, 25%, and 38%, respectively. Among breast specialists, more women tended to work at university hospitals and cancer hospitals. Twenty-eight percent of women were married and among those, 76% had at least one child. Many hospitals allow short working hours or exemption from in-house call for women surgeons during pregnancy and child-rearing. In contrast, half of the facilities apply a "single doctor-in-charge system", where the patient's primary physician has to be on-call every day. Many institutions convene conferences for breast cancer treatment planning before or after the scheduled working hours. CONCLUSIONS: Current systems for treatment of breast cancer should be improved so that all surgeons specializing in the breast can develop their career while maintaining their personal life.