Surgical fellowships demonstrate variable improvement in gender diversity despite more female General Surgery residents

Abstract

Background: Despite increasing female representation in General Surgery residency training programs, proportional improvement of female enrollment in surgical fellowships has yet to be quantified. We aim to assess if female enrollment in surgical fellowships has improved at an equivalent rate to General Surgery in 6 different surgical fellowship options after General Surgery. Methods: All data was collected from ACGME resources of active residents' characteristics. We collected self-reported gender data for General Surgery programs and surgical fellowships including Surgical Oncology, Pediatric Surgery, Critical Care Surgery, Plastic Surgery, Vascular Surgery and Thoracic Surgery from annual reports since 2013. As fellowship applicants come directly from the pool of General Surgery residents, we compared surgical fellowship data to General Surgery data from the equivalent year. Categorical analysis of gender enrollment between General Surgery and each surgical fellowship was performed for each year using Chi-squared analysis. Results: In all years examined, fellowships in Vascular Surgery, Thoracic Surgery and Plastic Surgery had significantly lower female enrollment in proportion to number of female General Surgery residents. Statistical output showed that proportional female representation even worsened in both Vascular and Thoracic fellowships in several studied years. In all years examined, Surgical Oncology, Pediatric Surgery and Critical Care Surgery had female enrollment that was not significantly different from the proportion of female General Surgery residents, indicating equitable and proportional enrollment. In fact, these fellowships each had one year where female enrollment was significantly higher than the proportion of female General Surgery residents. Conclusions: Surgical fellowships including Surgical Oncology, Pediatric Surgery and Critical Care Surgery had equitable enrollment of female surgeons over the past 10 years in proportion to representation in General Surgery. However, enrollment of female surgeons in Vascular Surgery, Thoracic Surgery and Plastic Surgery fellowships has not improved with the increase in female General Surgery residents. Our results suggest existence of persistent factors that prevent female enrollment in Vascular, Thoracic and Plastic Surgery fellowships. Our results also imply that these factors are not present in fellowships with equitable female enrollment, such as Surgical Oncology, Pediatric Surgery and Critical Care Surgery.