WHAT DOES GENDER HAVE TO DO WITH IT? A SCOPING REVIEW OF HOW GENDER INFLUENCES MEDICAL STUDENTS' CHOICE OF SURGICAL RESIDENCY PROGRAMMES

While the number of self-identified female medical students has steadily increased over the years, orthopedic surgery remains one of the most male-dominated specialties. Recent efforts have been aimed at encouraging more women to enter the field, as women represent nearly half of all medical students and ultimately some of the most qualified candidates. Numerous studies have examined the factors that may encourage or discourage women from pursuing a career in orthopedics from the perspective of practicing surgeons. Specific factors noted to possibly deter females include work life balance, physical strength requirements and a lack of female mentors. Ultimately, it is widely acknowledged that these career decisions are often shaped during medical school by factors that remain poorly understood. The purpose of this review was to identify factors that influence the decision to pursue a career in orthopedic surgery in self identified female medical learners. A comprehensive scoping review was completed looking at factors that influence North American medical students' choice of residency. Following the screening of 2027 titles and abstracts, 445 articles underwent full text review. A more focused review narrowed down articles that explored the impact of sex and gender in residency choice among medical students. There were 20 out of 445 articles that addressed gender within medical specialities. Of these, four articles were in surgery and only one specifically investigated factors that impact female medical students' interests in orthopedics. It was found that mandatory musculoskeletal teaching and early clinical exposure to orthopedics had a positive impact on female students. Negative perceptions that could deter female students included an overall negative attitude towards females in orthopedics, male dominance within the profession, difficulty with work life balance, increased physical demand and a lack of acceptance from senior faculty. Other surgical domain articles found that anticipated difficulty with family planning deterred female students from surgery. A positive factor linked to increased interest in surgery was access to female and minority mentors. For other medical specialties, more females were found to enter residency programs with a greater number of female residents. More research is needed to understand the opportunities to increase interest in orthopedic surgery residency programs, particularly for female medical students. Early exposure to orthopedic surgery with directed education regarding misconceptions surrounding the specialty could have promising effects. Future research should be focused on investigating positive factors influencing residency choice.