Gender Diversity in Orthopaedics: Are We Asking the Right Questions to the Correct Audience?

Category: Other Introduction/Purpose: Non-orthopaedic surgical specialties have demonstrated steady increases in female resident composition. Female participation in orthopaedics continues to lag behind. Prior surveys disseminated only to female orthopaedic surgeons have attempted to understand this deficit through an internal review approach. A survey of current female surgical residents across all specialties attempting to understand this discrepancy, to our knowledge, has not been conducted. We sought to address the following questions 1) What factors are most influential towards selection of surgical subspecialty? 2) What salient experiences and exposures among orthopaedic residents differ from those observed in the general surgery and other subspecialty cohorts? 3) What actionable steps can we as a profession take to ensure orthopaedic surgery is an open avenue to all who would like to pursue it? Methods: A 38-item survey was developed with the following subsections: Demographics, Pre-Clinical Exposures to Orthopaedics, Attitudes Towards Surgical Environments, Factors Influencing Specialty Choice, Dissuaders to a Career in Orthopaedics, and Work Experiences Related to Gender. Surveys were disseminated to current and incoming female surgical residents at university-affiliated surgical residencies in Ohio. Data collection occurred over 45 days during the 2022-2023 academic year. Continuous outcome measures were assessed using ANOVA. Categorical outcomes were compared using chi-square testing. Results: 76 surveys were included for final analysis with a response rate of 23.5% (76/324) including 23 (30.3%) orthopaedic surgery residents, 33 (43.4%) general surgery residents, and 20 (26.3 %) from other surgical subspecialties. Orthopaedic residents were more likely to have attended medical schools that offered orthopaedics as an elective rotation during their third year (p=0.04) and expressed more interest in the application of biomechanical principles to surgery compared to general surgery residents (p< 0.01) and other subspecialties (p=0.03). Low interest in orthopaedic conditions was the most cited dissuader to pursuing orthopaedics amongst general surgery (33.3%) and other subspecialties (40.9%). Interest in surgical techniques unique to specialty and exposure to them in medical school were uniformly ranked as the top two influential factors on specialty choice. Conclusion: Choosing a residency is a complex and multifactorial process. Lack of interest in orthopaedic pathology was found to be a primary driver in the decision not to pursue the field, though lack of exposure to orthopaedics was also ranked as a common dissuader. All female orthopaedic residents reported having the option for an elective third year medical school rotation in orthopaedic surgery. This option was relatively deficient amongst non-orthopaedic residents. Such findings may suggest that early exposure and purposeful mentorship incorporated into the fabric of medical school curricula, may result in increased consideration of orthopaedics as a future career.