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

Abstract

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.

Factors That Influence Undergraduate Medical Students to Choose General Surgery as a Future Career in Saudi Arabia

“…This contradicted the report of Acai et al ( 2020), wherein medical students' preference for choosing a career as a general surgeon increased significantly after the sixth year, and the prevalence was higher in males [17]. Moreover, our study data indicates that female medical students are inclined towards selecting a general surgery specialty due to research opportunities, a less stressful environment, reduced working hours, and having family members in the same field [18]. In contrast, male students prioritize the social standing associated with the specialty.…”

Overcoming the Barriers to Diversity in Orthopaedic Surgery

“…Research has shown that approximately 80% of medical students in the U.K. have orthopaedic placements 81 in comparison with just 20% of those in the U.S. 82 , but the U.K. orthopaedic workforce is not appreciably more diverse than that of the U.S. In addition, a study found that clinical exposure did not significantly improve the likelihood of female medical students choosing orthopaedic surgery as a career in Saudi Arabia 47 .…”

“…45 A study of attitudes in the U.K. found that 24% of female medical students would consider a career in orthopaedic surgery 46 . In comparison, that rate was found to be 11% among female medical students in Saudi Arabia 47 . Surveys of medical students and of junior doctors have shown that perceived structural and cultural barriers may contribute to a reduced likelihood of applying to orthopaedics 48,49 .…”