Abstract

INTRODUCTION: The number of women graduating from U.S. medical schools has reached parity with that of men. However, persistent inequalities and barriers have made the pace towards equity in application and representation in neurosurgery residency slow despite initiatives to increase female representation. METHODS: Data on the number of active female neurosurgery residents and female applicants to neurosurgery was collected from the American Council of Graduation Medical Education Data Resource Book from 2007 to 2021 and Electronic Residency Application Service from 2014 to 2022, respectively. Bivariate linear regression analysis was used to predict percent of active female residents based on academic year (AY). Pearson Chi-squared was conducted to determine the odds ratio of a female applicant to neurosurgery. RESULTS: The percent of active female residents in neurosurgery increased from 11.0% in 2007 to 21.8% in 2021. Bivariate linear regression analysis using AY as predictor of percent of active females was statistically significant. On average, the percent of active female residents increases by 0.65% per year. If trends persist, parity in neurosurgery will not be reached until 2069. Linear regression analysis of the overall rate of attrition in neurosurgery as a predictor of percent of active female residents revealed that for every 1% increase in rate of attrition the percent of active female residents decreases between 1.4% to 4.4%. The percent of female applicants to neurosurgery increased from 19.6% in 2014 to 29.8% in 2022, yet the odds of a female applying to neurosurgery remains low. CONCLUSIONS: Neurosurgery continues to struggle with recruitment of female medical students, despite achievement of parity for female medical school matriculants. Greater effort is needed to recruit and retain female applicants to neurosurgery, including increased transparency in match and attrition metrics.

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