Links between age and sex of surgeons and patients’ outcomes

Coburn, Natalie; Wallis, Christopher J.D.; Baxter, Nancy N.

doi:10.1136/bmj.k1691

Cited by 4 publications

(4 citation statements)

References 7 publications

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“…In each case, women physicians experienced difficulty establishing themselves as leaders in the OR, and regardless of the strategy used, did not obtain the desired result. This type of dilemma has been well-documented in other studies, where women in leadership positions have to find a balance between challenging traditional gender roles or conforming to them, with each choice having potential social and career consequences [ 16 , 40 , 47 , 49 , 50 ]. Future work may further explore the role of gender within the professional socialization of surgeons and anesthesiologists, and how this translates to leadership behaviours.…”

Section: Discussionmentioning

confidence: 94%

How gender shapes interprofessional teamwork in the operating room: a qualitative secondary analysis

Etherington

Kitto

Burns

et al. 2021

BMC Health Serv Res

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Background Despite substantial implications for healthcare provider practice and patient outcomes, gender has yet to be systematically explored with regard to interprofessional operating room (OR) teamwork. We aimed to explore and describe how gender and additional social identity factors shape experiences and perceptions of teamwork in the OR. Methods This study was a qualitative secondary analysis of semi-structured interviews with OR team members conducted between November 2018 and July 2019. Participants were recruited across hospitals in Ontario, Canada. We conducted both purposive and snowball sampling until data saturation was reached. Transcripts were analyzed thematically by two independent research team members, moving from open to axial coding. Results Sixty-six interviews of OR healthcare professionals were completed: anesthesia (n=17), nursing (n=19), perfusion (n=2), and surgery (n=26). Traditional gender roles, norms, and stereotypes were perceived and experienced by both women and men, but with different consequences. Both women and men participants described challenges that women face in the OR, such as being perceived negatively for displaying leadership behaviours. Participants also reported that interactions and behaviours vary depending on the team gender composition, and that other social identities, such as age and race, often interact with gender. Nevertheless, participants indicated a belief that the influence of gender in the OR may be modified. Conclusions The highly gendered reality of the OR creates an environment conducive to breakdowns in communuication and patient safety risks in addition to diminishing team morale, psychological safety, and provider well-being. Consequently, until teamwork interventions adequately account for gender, they are unlikely to be optimally effective or sustainable.

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Section: Discussionmentioning

confidence: 94%

How gender shapes interprofessional teamwork in the operating room: a qualitative secondary analysis

Etherington

Kitto

Burns

et al. 2021

BMC Health Serv Res

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“…In Reply We thank the Letter writers for their interest in our work and the editors for the opportunity to respond. To contextualize this work, women compose a small proportion of surgeons and have faced many training and professional challenges . Thus, we wish to highlight the comment of Liao et al, who said that “female surgeons may not receive fair evaluation for…their achievements.” The Letters raise both methodologic considerations and those that relate to its implications.…”

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confidence: 99%

Comments on Surgeon-Patient Sex Concordance and Postoperative Outcomes—Reply

2022

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In Reply As Bai et al note, general surgery has historically been a (White, cisgendered, heterosexual) male-dominated field. Our data indicate lack of inclusion is experienced by many with minoritized identities in surgery, including lesbian, gay, bisexual, transgender, queer, and other sexual and gender minority (LGBTQ+) physicians. We agree that this lack of inclusion likely leads LGBTQ+ residents to withhold their identity. In our survey of 85.6% of all residents training in accredited general surgery programs, 305 (4.8%) self-identified as LGBTQ+, and 394 residents did not answer or selected "prefer not to answer." Based on US Census data and prior work 1 demonstrating that more than half of LGBTQ+ surgery residents choose not to disclose their identity, we too suspect our study undercounts LGBTQ+ surgery residents and therefore underestimates LGBTQ+-based mistreatment. Even if residents are able to avert mistreatment by withholding LGBTQ+ identity, the inability to authentically express one's identity causes psychological distress and difficulty connecting with colleagues. 2 Therefore, an environment in which it is safe to disclose identity is essential to the well-being of LGBTQ+ trainees.A growing body of literature supports improved patient outcomes with physician diversification. Physicians from minoritized groups are more likely to work with underserved communities, improving access to care. 3 Patient-physician identity concordance reduces morbidity and mortality for patients with minoritized identities. 4,5 Even care provided by physicians who are not from minoritized groups likely improves because exposure to colleagues from minoritized groups durably reduces their biases. 6 Thus, developing strategies to foster and support a diverse surgical workforce is our moral imperative, not only for the sake of LGBTQ+ surgeons, but for all patients.We are currently working with programs across the US to develop targeted interventions to address mistreatment and well-being for the Surgical Education Culture Optimization Through Targeted Interventions Based on National Comparative Data (SECOND) Trial. Although we urge all programs, and certainly those in other countries, to be mindful of their local cultural context (eg, in the acceptance and construction of LGBTQ+ identities) as they implement our interventions within their training environments, we submit that the following principles are universal: (1) Representation matters. Many training and/or physician organizations do not query sexual orientation or gender identity, making disparities challenging to scope and normalizing invisibility. Diversification of training programs, from both a resident and faculty standpoint, is critical. To this end, resources that support the work, well-being, and therefore recruitment and retention of LGBTQ+ surgeons should be made available. (2) As Bai et al highlight, more education is needed for both trainees and faculty. Content should address basic vocabulary and rules of respectful conduct (eg, Why do pronouns matter? Wha...

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“…Yet, women still compose a small proportion of surgeons and have faced many training and professional challenges [ 23 , 24 ]. In the United States, although 50% of medical students and 40% of general surgery residents are female [ 25 ], less than 25% of doctors in ten surgical specialties are female [ 11 ].…”

Section: Discussionmentioning

confidence: 99%

Donor, Recipient and Surgeon Sex and Sex-Concordance and their Impact on Liver Transplant Outcome

Mazilescu

Bernheim

Treckmann

et al. 2023

JPM

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(1) Background: Patient sex is associated with differential outcome of many procedures although the exact mechanisms remain unknown. Especially in transplant surgery, surgeon-patient sex-concordance is rarely present for female patients and outcome may be negatively affected. (2) Methods: In this single-center retrospective cohort study, recipient, donor, and surgeon sex were evaluated and short- and long-term outcome was analyzed with regards to sex and sex-concordance of patients, donors, and surgeons. (3) Results: We included 425 recipients in our study; 50.1% of organ donors, 32.7% of recipients, and 13.9% of surgeons were female. Recipient-donor sex concordance was present in 82.7% of female recipients and in 65.7% of male recipients (p = 0.0002). Recipient-surgeon sex concordance was present in 11.5% of female recipients and in 85.0% of male recipients (p < 0.0001). Five-year patient survival was comparable between female and male recipients (70.0% vs. 73.3%, p = 0.3978). Five-year patient survival of female recipients treated by female surgeons was improved without reaching significance (81.3% vs. 68.4%, p = 0.3621). (4) Conclusions: Female recipients and female surgeons are underrepresented in liver transplant surgery. Societal factors influencing outcome of female patients suffering from end-stage organ failure need to be further examined and acted upon to possibly improve the outcome of female liver transplant recipients.

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Links between age and sex of surgeons and patients’ outcomes

Abstract: Unravelling these complex associations will benefit both patients and surgeons

Cited by 4 publications

References 7 publications

How gender shapes interprofessional teamwork in the operating room: a qualitative secondary analysis

How gender shapes interprofessional teamwork in the operating room: a qualitative secondary analysis

Comments on Surgeon-Patient Sex Concordance and Postoperative Outcomes—Reply

Donor, Recipient and Surgeon Sex and Sex-Concordance and their Impact on Liver Transplant Outcome

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