Gender divergence: scoping the surgical gap.

Abstract

Women constitute 62 per cent of UK medical school entries, yet the percentage in higher surgical training is half this (32 per cent), and the proportion of female consultants on the specialist register is only 14 per cent1. Hidden curricula are subtle value-based lessons with moral undertones; they are absorbed without explicit intention but may perpetuate and boost existing disparities such as gender bias. Gender stereotypes continue to prevail in modern cultures, with female attributes considered warmer and more caring than the colder and more confident male behaviour. Moreover, straying from such traditional dogma can lead to negative perceptions. Microaggression is also prevalent, and defined as subtle insults and hostility toward minority stigmatized groups, including women2. Infertility among doctors is high, with one in four female physicians experiencing conception difficulties, compared with the general population rate of 9–18 per cent3. Challenging on-call rotas and long geographical commutes can make pregnancy daunting. Female surgeons, in particular, have been reported to have significantly higher rates of infertility, with 32 per cent of a cohort of female US residents experiencing difficulties4. Arguably, higher infertility may be due to decisions to defer starting families until training has completed, and Rangel et al. reported that 65 per cent of studied female surgeons delayed pregnancy because of training-related concerns5. The average age for their first pregnancy was 33 years, compared with 31 years in controls, and the effect of age on fertility is well recognized. Moreover, miscarriage rates among female surgeons have been reported to be 42 per cent, double that of the general population5. Rates of pregnancy complications (intrauterine growth retardation, placental abruption, preterm labour, and low birthweight) have also been reported to be significantly higher in female surgeons, with 48 per cent suffering major morbidity, compared with 27 per cent in non-surgeon partners6. Pregnant surgeons also suffered higher rates of emergency caesarean section, musculoskeletal disorders, and postnatal depression. Operating for 12 hours or more per week during the third trimester of pregnancy was shown to increase morbidity 1.5-fold5. Mohan et al. reported that 27.1 per cent of UK and Republic of Ireland female surgeons felt unsupported during pregnancy7.