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Women in Healthcare

Changing the Climate in the O.R. Starts in the Classroom

Susan Steinemann, MD, FACS

Immediate Past-President, Association for Surgical Education, and Professor of Surgery, University of Hawaii John A. Burns School of Medicine

Over the past few decades, the field of surgery has rapidly advanced through innovations in diagnostic techniques, operative approaches, and surgical tools. However, perhaps the change which has had the greatest impact upon patient outcomes has been the diversification of the surgical workforce.

Leaps and bounds to go

In 1980, only two percent of all surgical residents were women. Today, women comprise 15-40 percent of surgical residents (depending on specialty); but they are still relatively underrepresented given that medical school classes have almost equal numbers of men and women. 

Medical students perceive the profession of surgery as “competitive” and “masculine.”  Women residents and students on their surgical rotation tend to underestimate their skill relative to objective measures of performance. Yet, studies demonstrate that process measures and patient outcomes with women surgeons are equal or superior to their male colleagues. 

Gender bias in the O.R.

Gender bias, work-life balance, and a dearth of role models are frequently cited for reasons why women avoid, or later abdicate, a career in surgery. These obstacles must be addressed early and reassessed often. Medical students need early indoctrination to the concept of women surgeons. This can occur, most obviously, through faculty mentoring and early clinical immersion opportunities. 

However, other opportunities exist to increase awareness, interest, and acceptance of women in the field. This can be as simple as creating nuanced, problem-based learning scenarios featuring women surgeons to address or debunk common concerns and perceptions. This include the misperception one needs masculine physical strength to be an orthopedic surgeon, the inability to operate when pregnant or nursing, or that gender hinders patient communication.

Who’s making a difference

National surgical societies such as the Association of Women Surgeons and the American College of Surgeons (Women in Surgery Committee, Committee on Medical Student Education) can help connect students with role models and resources. 

The Association for Surgical Education (ASE), is a 900-member international organization committed to the values of inclusivity and collegiality. The ASE’s website and its annual conference (during Surgical Education Week), provides both students and faculty the construct and tools that allow exploration and mitigation of gender bias in surgery. Students can be inspired by the many women role models, and learn the policies and programs which aim to protect and support diversity in surgery. My message to prospective women surgeons is, “Yes, you can.” My message to my colleagues is, “Yes, we must” continue to work toward optimizing our surgical workforce through gender equity — starting in the classroom.

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