Barriers to Women Entering Surgical Careers: A Global Study into Medical Student Perceptions

Abstract

Background Barriers to female surgeons entering the field are well documented in Australia, the USA and the UK, but how generalizable these problems are to other regions remains unknown. Methods A cross-sectional survey was developed by the International Federation of Medical Students' Associations (IFMSA)'s Global Surgery Working Group assessing medical students' desire to pursue a surgical career at different stages of their medical degree. The questionnaire also included questions on students' perceptions of their education, resources and professional life. The survey was distributed via IFMSA mailing lists, conferences and social media. Univariate analysis was performed, and statistically significant exposures were added to a multivariate model. This model was then tested in male and female medical students, before a further subset analysis by country World Bank income strata. Results 639 medical students from 75 countries completed the survey. Mentorship [OR 3.42 (CI 2.29-5.12) p = 0.00], the acute element of the surgical specialties [OR 2.22 (CI 1.49-3.29) p = 0.00], academic competitiveness [OR 1.61 (CI 1.07-2.42) p = 0.02] and being from a high or upper-middle-income country (HIC and UMIC) [OR 1.56 (CI 1.021-2.369) p = 0.04] all increased likelihood to be considering a surgical career, whereas perceived access to postgraduate training [OR 0.63 (CI 0.417-0.943) p = 0.03], increased year of study [OR 0.68 (CI 0.57-0.81) p = 0.00] and perceived heavy workload [OR 0.47 (CI 0.31-0.73) p = 0.00] all decreased likelihood to consider a surgical career. Perceived quality of surgical teaching and quality of surgical services in country overall did not affect students' decision to pursue surgery. On subset analysis, perceived poor access to postgraduate training made women 60% less likely to consider a surgical career [OR 0.381 (CI 0.217-0.671) p = 0.00], whilst not showing an effect in the men [OR 1.13 (CI 0.61-2.12) p = 0.70. Concerns about high cost of training halve the likelihood of students from low and low-middleincome countries (LICs and LMICs) considering a surgical career [OR 0.45 (CI 0.25-0.82) p = 0.00] whilst not demonstrating a significant relationship in HIC or UMIC countries. Women from LICs and LMICs were 40% less likely to consider surgical careers than men, when controlling for other factors [OR 0.59 CI (0.342-1.01 p = 0.053]. Conclusion Perceived poor access to postgraduate training and heavy workload dissuade students worldwide from considering surgical careers. Postgraduate training in particular appears to be most significant for women and cost of training an additional factor in both women and men from LMICs and LICs. Mentorship remains an important and modifiable factor in influencing student's decision to pursue surgery. Quality of surgical education showed no effect on student decision-making.

The experiences of female surgeons around the world: a scoping review

“…[ 122 ] High income United States Questionnaire n = 107 100% Not reported Residency and training Year Title World Bank Income Group Country Study design Population size Gender distribution (M/F) % Female Funding source 2020 Barriers to Women Entering Surgical Careers: A Global Study into Medical Student Perceptions. [ 18 ] All levels 75 Countries ψ Questionnaire n = 639 (374/265) 59% Not reported 2020 Sexual Harassment and Cardiothoracic Surgery: #UsToo? [ 15 ] Unknown Unknown ∓ Questionnaire n = 790 (185/591) 23% Not reported 2020 Women Continue to Be Underrepresented in Surgery: A Study of AMA and ACGME Data from 2000 to 2016.…”

“…In particular, no literature on female surgeons was available from Central and South America, despite evidence of women working as surgeons in this region [ 82 ]. More importantly, this review has demonstrated that differences in culture, economic and educational opportunity, gender equity and women’s empowerment affect the experiences of both female surgical trainees and current female surgeons [ 3 , 18 , 83 ].…”

“…Two articles studied UMICs exclusively (South Africa by Umoetok et al[ 28 ] and Turkey by Eyigor et al [ 29 ]) and one article focused on a LIC, Rwanda [ 30 ]. Two studies examined populations from multiple income levels [ 15 , 18 ].…”

Editorial. International women leaders in neurosurgery: past, present, and what the future must look like

“…Unconscious bias and microaggression are strongly associated with the choice to enter neurosurgical training and pursue career progression. 3 Unconscious or implicit bias are attitudes or stereotypes that affect our understanding in an unconscious manner; microaggression follows, as actions subtly and often unintentionally hostile to a minority group. Both are pervasive and present throughout life and influence perception of the likelihood of a leadership career in neurosurgery.…”

Potential long-term impacts of surgical placement cancellations

“…Diversity in medicine and surgery is important as it leads to more inclusive and patient-centred care, increased patient compliance, satisfaction and participation in clinical trials, and greater access to care for disenfranchised communities [4]. There remains a lack of representation of minority groups in positions of leadership in surgery [5], and mentorship is a crucial factor in promoting a career in surgery [6][7][8][9][10]. Roberts SE et al found that the perceived barriers preventing African Americans from pursuing a career in surgery included 'lack of mentorship', 'difficulty finding minority role models', and 'fighting stereotypes' [11].…”