Women In Orthopaedics Research Articles

699 Gender Inequality in Orthopaedic Radiation Protection: An Audit

Abstract Aim The literature demonstrates an increased prevalence of breast cancer in female orthopaedic surgeons compared to the population baseline. One contributor to this alarming statistic may be exposure to frequent low-dose radiation inherent to orthopaedics. The British Orthopaedic Association (BOA) has emphasised the importance of wearing lead aprons that provide adequate coverage, especially of the axillary region in women. To assess the availability of vests that fulfil such criteria, an audit of the lead aprons available at our local adult tertiary centre was undertaken. Method Lead protective equipment used by the orthopaedic theatres were documented by type, size, and brand. Data collection occurred prior to theatre activity requiring lead use, to ensure all equipment was present. Results 115 pieces of equipment were identified - 43 standard vests, 9 tabard gowns with side coverage, 4 tabard gowns without side coverage, 48 skirts and 11 thyroid covers. Vests, skirts, and tabard gowns ranged from XS (n=4), S (n=21), M (n=15), L (n=46), to XL (n=12), unidentifiable size (n=6). Vests, skirts and tabard gowns ranged from several different brands including Xenolite Male (n=45), Xenolite Female (n=29) and Kenex (n=23). No boleros, high axilla vests, or vests with wings/sleeves/axillary shields, were identified. Conclusions This audit demonstrated inadequate adherence to BOA recommendations and a lack of size diversity. With increasing numbers of women in orthopaedics, there is a need to raise more awareness and address this safety concern to mitigate a larger concerning trend.

Women in Orthopaedics: 10-Year Trends of Fellowship Match Rate and Subspecialty.

Orthopaedic surgery has consistently remained one of the least diverse specialties in medicine. There are limited data on the match rate by sex into orthopaedic fellowships. The goals of this study were to determine (1) how the percentage of women applying to orthopaedic fellowships has changed from 2011 to 2021, (2) whether there was a correlation between sex and the likelihood of a successful fellowship match, and (3) which subspecialties tend to have a greater proportion of female applicants and fellows. The San Francisco (SF) Match service was used to obtain US orthopaedic fellowship applicant data from 2010 to 2021. San Francisco Match has run the match for the orthopaedic fellowship match since 2010. International medical graduates' applications, incomplete applications, or withdrawn applications were excluded. The following variables were collected and assessed: sex, subspecialty choice (except for hand because they do not use SF Match services), and match outcome. The number of female applicants and matches was recorded by year and compared with the number of male applicants and matches. Chi-square analysis was used to analyze categorical variables. A total of 6969 applicants to all orthopaedic specialties within SF Match were included during the study period. Overall, 859 were female (12.3%), and 6110 were male (87.7%). The number of female applicants had an increasing trend over the 10-year period from 65 applicants in 2011 to 111 in 2021. The overall proportion of female applicants was between 10.1% and 14.4%. The annual match rate for female applicants was 90.7% to 100% during the study period while the match rate for male applicants was 93.7% to 97.3%. Regarding successful matches, pediatrics had the highest proportion of women (range: 30.2% to 46.2%), followed by foot and ankle (range: 9.8% to 26.4%). Spine (range: 3.2 to 10.9%) and adult reconstruction (range: 3.9% to 9%) had the least number of women among matched applicants. This study found that the number of female applicants to orthopaedic fellowships has increased over the past 10 years. The difference in fellowship match rates among male versus female applicants did not statistically differ during this 10-year period; however, the proportion of female fellows is not equally distributed among subspecialties, with a higher proportion of women matching into pediatrics and foot and ankle and lower proportion in reconstruction and spine. These data can provide a benchmark for department chairs and society leadership to ensure they are recruiting, interviewing, and selecting candidates who are representative of the current sex demographics of orthopaedic fellowship graduates.

Women's Representation as Principal Investigators Among Pediatric Orthopaedic Clinical Trials: An Analysis of ClinicalTrials.Gov.

Despite recent efforts to increase the participation of women in orthopaedic surgery, there remains a gender gap, particularly when compared with other medical specialties. Acting as a principal investigator (PI) in a clinical trial can give physicians notable exposure and national recognition, which can improve their chances of promotion and tenure. This study aims to assess the proportion of women serving as PIs in pediatric orthopaedic clinical trials, examine associated trial characteristics, and explore geographic distribution. A cross-sectional analysis of clinical trials was conducted using data from the ClinicalTrials.gov registry. Specific search terms were used to identify pediatric orthopaedic trials. Data on trial characteristics, including phase, status, funding source, and intervention type, were collected. PI sex was determined using Genderize.io, an application program interface that predicts the sex of individuals based on their name, and the geographic distribution of women PIs was examined. From 2007 to 2022, women PIs increased from zero to 26.86%. The United States saw no significant increase (β = 1.553; P = 0.125), but international trials did (β = 2.845; P = 0.008). Women PIs led more active/completed trials and trials with behavioral/other interventions. Geographic analysis showed higher representation in North America (38.47%), especially the Northeast (28.17%) and West (25.35%). The United States had 28.74% women PIs, with California (15.49%) leading. Progress toward gender parity in pediatric orthopaedic research is evident; however, disparities still exist. Efforts to provide additional research opportunities for women in orthopaedics may be crucial in attracting and retaining diverse talent in the field. Targeted initiatives may have potential in achieving equal representation in orthopaedics.

Perception and Usage of Social Media Among Women in Orthopaedics.

The use of social media for marketing, education, and networking has increased among orthopaedic surgeons. Social media has played an important role in supporting women physicians and trainees, by allowing connections to be made across stages of training and geographic borders. The purpose of this study was to determine the perceptions of female orthopaedic surgeons, fellows, residents, and medical students regarding their usage of social media. A 22-question anonymous survey regarding the perceptions of social media usage was distributed to 1,189 female members of Ruth Jackson Orthopaedic Society via e-mail in July 2022. Data collection lasted a total of 4 weeks, from July to August 2022. Data analysis was performed using descriptive statistics. A total of 207 responses were received (17% response rate). The respondents comprised 90 orthopaedic surgeons (43%), 60 medical students (29%), 49 residents (24%), and eight fellows (4%). Ninety one percent of participants (189 of 207) reported having a social media account, with 23% (43 of 189) having separate 'personal' and 'professional' accounts. Less than half of all participants reported altering (51 of 189; 27%) or deleting (20 of 189; 11%) profiles for interviews. Fifty three percent of participants (109 of 207) 'agreed' that social media is a good way to network. Twenty eight percent of participants (58 of 207) feared gaining attention to their profile when engaging with professional accounts. Forty percent of participants (62 of 207) agreed that personal life events on social media can be considered unprofessional and should be kept on a private profile. Social media can be used to network professionally within orthopaedic surgery, connecting women at different levels of training. Although concerns about professionalism of social media accounts exist, this may be mitigated by maintaining a separate private account from a public, professional profile. Future guidelines regarding social media usage and how to maintain professionalism while being active on social media may be beneficial.

The Importance of Perceived Barriers to Women Entering and Advancing in Orthopaedic Surgery in the US and Beyond.

Global perceptions of barriers to women in orthopaedics have not been assessed. The purpose of this study was to determine the importance of international barriers to women entering and advancing within orthopaedic surgery. An anonymous, online survey was distributed to women medical students, trainees, and practicing surgeons via Women in Orthopaedics Worldwide, the "Women in Ortho" Facebook page, and individual programmes. Participants were asked to rate perceived barriers to (1) pursuing training and (2) career advancement on a scale of 1-5, with 5 being the most important and relative to other barriers. Descriptive statistics and univariate analyses were employed. The survey yielded 237 US (84.0%) and 45 international (16.0%) respondents. Per entering orthopaedic surgery, the most important barriers were male-dominated culture, lack of a strong women mentor, and lack of female representation at home institution. Compared with the US surgeons/trainees, international respondents cited greater societal disapproval (2.8 ± 1.2 vs. 3.4 ± 1.3, P = 0.01). Medical students assigned less importance to lack of exposure, more to lack of resources for creating competitive applications (P < 0.05). Regarding career advancement, lack of women leadership, family responsibilities, and gender-biased selection for promotion were the most important. International surgeons/trainees noted greater concern for societal disapproval (3.5 ± 1.5 vs. 2.6 ± 1.3, P = 0.003) and were more likely to rank sexual harassment in their top three (17.6 vs. 4.2%, P = 0.02). While notable differences exist, there is striking similarity across countries and position levels in perceived barriers to women entering and advancing in orthopaedic surgery. III.

Trends in Female Authorship in Orthopaedic Literature from 2002 to 2021: An Analysis of 168,451 Authors.

Significant gender disparity exists in orthopaedic surgery. While women have increasingly entered the field, we are short of the critical mass needed to drive change, including in authorship. This study aimed to characterize trends in authorship in peer-reviewed orthopaedic journals in the context of gender. This is a cross-sectional bibliometric study of orthopaedic journals in the United States. Articles that were indexed in the orthopaedic category of the Clarivate Journal Citation Report (JCR) and the Science Citation Index Expanded (SCIE) were analyzed (n = 82). Journals not originating from the U.S. (n = 43) or not considered primarily orthopaedic journals (n = 13) were excluded. The 2020 impact factors (IFs) of the remaining 26 journals were recorded. The articles underwent automated data collection from PubMed for January 2002 to December 2021 using R software to collect the title, the journal, the publication year, the first and senior author names, and the country of origin. Gender was determined by Gender API ( https://gender-api.com ). Names with <90% accuracy were excluded. Overall, 168,451 names were studied, with 85,845 and 82,606 first and senior authors, respectively. Of the first and senior authors, 13.6% and 9.9%, respectively, were female. The proportion of female first authors was significantly greater than the proportion of female senior authors. The average IF was significantly higher for male authors compared with female authors (p < 0.005). Articles with female first authors were significantly more likely to have a female senior author. Orthopaedic subspecialty journals had a smaller proportion of manuscripts authored by female first and senior authors than general journals (p < 0.0001). There were 4,451 articles written by a single author, of which 92% (4,093) were written by a man and 8% (358) were written by a woman. Over the 20-year study period, the proportion of female first authorship exhibited a significant positive trend; however, there was a non-significant increase in female senior authorship. Female representation in orthopaedics has been growing over the past decade. Increasing publication rates of female authors reveal steps toward positive gender equity in the field and present an opportunity for female leadership visibility, illustrating the capabilities of women in orthopaedics and encouraging more women to join the field.

Women in Orthopaedics: A Perspective from Malaysian Female Orthopaedic Surgeons.

The awareness of under-representation of female surgeons in orthopaedics has been increasing in this decade. We aim to investigate the reasons why female surgeons chose orthopaedic, the barriers that possibly hinder female surgeons into orthopaedics and analyse the obstacles that they encountered in their career in Malaysian context. A total of 101 registered female orthopaedic surgeons registered with the Malaysian Medical Council, during the period 1980 to 2020, were contacted for a cross-sectional survey, consisting of thirty-four questions on their experience in the orthopaedic career. Eighty-two responses were received (81.2%). Questions in this survey consisted of four sections: (1) demographic details, (2) current clinical practice environment, (3) orthopaedics training experience, and (4) career experience. A total of 49% of respondents had subspeciality training, highest in paediatric orthopaedic (30%). Enjoyment of manual tasks (64.6%) and professional satisfaction (64.6%) were the top reasons for choosing orthopaedic as a career. Primary barriers to orthopaedic were physical strength required (56.0%) and public gender bias (52.4%). Twenty-eight percent reported gender discrimination in career opportunities while 60% reported similar in daily work. Thirty-three percent reported verbal and 11% physical sexual harassment in their career. Forty-four percent of respondents reported benefits as female orthopaedic surgeon in their work. The reasons for Malaysian female orthopaedic surgeons to choose orthopaedic as their career and the barriers perceived to hinder other females from choosing orthopaedics were similar to reports worldwide with no exception to gender discrimination and sexual harassment. The support given by male colleagues to married female surgeons marked a unique phenomenon in Malaysian culture.

Representation of Female Speakers at the American Academy of Orthopaedic Surgeons Annual Meetings Over Time.

In the United States, women comprise 16% of orthopaedic surgery residents, 4% of fellows, and 6% of practicing orthopaedic surgeons. The underrepresentation of women in surgical subspecialties may be because of lack of early exposure to female mentors. Conference speaker roles are important for visibility. This study aims to evaluate the representation of women in speaker roles and responsibilities at the American Academy of Orthopaedic Surgeons (AAOS) meetings over time. The names of speakers and session titles at the annual AAOS meetings were obtained from conference programs for the years 2009, 2014, and 2019. Each speaker was classified based on sex and role. Sessions discussing scientific or surgical topics were classified as technical and those that did not were classified as nontechnical. Descriptive statistics are provided, as well as individual-year odds ratios (ORs) and confidence intervals (CIs) examining sex versus technical session status and sex versus speaker role; combined results controlling for year are calculated using the Cochran-Mantel-Haenszel method. Overall, 3,980 speaking sessions were analyzed; 6.8% of speaking sessions were assigned to women. Women were more likely than men to participate in nontechnical speaking roles (OR 3.85; 95% CI, 2.79 to 4.78). Among talks given by women, the percentage that were nontechnical increased (25.5% in 2009, 24.3% in 2014, and 44.1% in 2019). Among moderator roles, the percentage assigned to women increased (4.5% in 2009, 6.0% in 2014, 14.5% in 2019). Our findings demonstrate an increase in female speakers at AAOS meetings from 2009 to 2019. The percentage of female moderators and nontechnical sessions given by women increased since 2009. A need for a shift in the distribution of speaker role exists, which promotes inclusivity and prevents professional marginalization. Representation of women as role models increases visibility and may address the leaky pipeline phenomenon and paucity of women in orthopaedics.

Representation of women in orthopaedic surgery: perception of barriers among undergraduate medical students in Saudi Arabia

BackgroundWhile female participation has improved in several surgical specialties over time globally, no such increase has been observed in orthopaedic surgery over the past decades. The potential barriers to female participation are likely present from the beginning of medical education. Therefore, this study assessed the apparent lag in equal representation among men and women in orthopaedic surgery in the Kingdom of Saudi Arabia.MethodsThis cross-sectional study used a questionnaire survey to investigate medical students’ and interns’ perceptions of women participating in orthopaedic surgery, their subspeciality preferences, and barriers preventing them from pursuing an orthopaedic career. The responses were analysed to understand general perceptions, gender-based differences, impact of clinical experiential learning, and exposure to orthopaedic surgery.ResultsApproximately 565 medical students (49% females, 51% males) participated in the survey. Only 17% of students (11% females, 23% males) considered orthopaedic surgery as their future career option. While 31% of female and 17% of male students disagreed with the concept of female-appropriate orthopaedic subspecialties, most of the remaining male and female students perceived paediatric orthopaedics as a female-appropriate subspecialty. Concerning equal representation of women, gender bias and lack of a strong physique were the most frequently selected barriers by female and male students, respectively. Patient preference for male orthopaedicians, gender discrimination, social and family commitments, and need for physical strength were all perceived as barriers for women in orthopaedics. Overall, clinical experience and orthopaedic exposure did not significantly improve the likelihood of female students in choosing orthopaedic surgery as a career.ConclusionsThe bias against women in orthopaedic careers is prevalent among medical students early in their academic years. Clinical experience and exposure to orthopaedic surgery should be improved to make a significant impact on female participation in orthopaedic careers. Career building efforts in terms of improved career opportunities, career counselling, flexible working hours, social and family related adjustments and implementation of mentorship/research/fellowship programmes for females are needed to reduce gender discrimination and improve female orthopaedic participation. Furthermore, process improvements may yield greater flexibility for women pursuing the challenging field while accommodating other barriers faced by women in orthopaedic surgery.

The other side of conflict: Examining the challenges of female orthopaedic surgeons in the workplace

BackgroundAs more women begin to enter the traditionally male-dominated field of orthopaedics, it is critical to examine their experiences in navigating gender-based conflicts in the workplace. MethodsAn anonymous survey was distributed via a web link to approximately 1,100 members of Ruth Jackson Orthopaedic Society (RJOS) and 1,600 members of Women in Orthopaedics (WIO) Facebook group, with an estimated response rate of 50% and 50% respectively and protocols to mitigate duplicate response. Questions included demographics and presented several workplace scenarios. ResultsOf the 373 respondents, 72% described experiencing some type of workplace conflict self-attributed to being female. Additionally, 8% reported either being forced out or leaving their previous job due to workplace conflict, leading to depression, anxiety, and burnout. 17% of respondents would not choose the same career again if given the opportunity. ConclusionsWorkplace conflict diminishes a surgeon's career satisfaction and may ultimately contribute to burnout. Understanding the relationship between gender bias and orthopaedic surgery is essential in moving towards change, and addressing these issues will create a more positive working environment for female surgeons.

The “Other Side” of Conflict: examining the challenges of female orthopaedic surgeons in the workplace.

Introduction Gender bias has not been studied extensively within orthopaedic surgery, where only 8% of practicing orthopaedic surgeons in the US identify as female. As more women enter the field, it is critical to examine female orthopaedic surgeons’ experiences in navigating conflict and its impact on their career and wellbeing. Methods An anonymous 54-question survey was distributed through the Ruth Jackson Orthopaedic Society membership roster (n=1.1K) and Women in Orthopaedics (n=1.6K), an online group exclusive to female orthopaedic surgeons in practice/training. Questions inquired about several workplace conflict scenarios. Results There were 373 female respondents. 55% were between 35 and 45 years old, 79% were White/Caucasian, 10% Asian/Asian American, 4% Black/African American, and 4% Hispanic/Latinx. Results showed that 73% had been described as “bossy, too assertive, pushy, demanding, or difficult”, 80% had to do more administrative work in clinic than their male counterparts, and 51% had been reported for behaviors that a male counterpart had not. Respondents who were reported noted depression (n=40), anxiety (n=69), burnout (n=85), and sleep disturbances (n=48) as emotional effects of the event. Additionally, 29 respondents reported being forced out or leaving their previous job due to workplace conflict. When asked if they would choose the same career again, 21% said no. Discussion Female orthopaedic surgeons encounter unique workplace challenges that diminish career satisfaction and contribute to burnout. Understanding and acknowledging this relationship between gender bias and orthopaedic surgery is essential to create a more positive working environment for female orthopaedic surgeons and encourage incoming trainees.

Women in orthopaedics: what does the future hold? let’s not forget the past

Women in orthopaedics: what does the future hold? let’s not forget the past

The Perry Initiative: Building the Pipeline for Women in Orthopaedics.

From the The Perry Initiative Newark (Buckley, Dearolf, Dr. Lattanza), DE, the Department Mechanical Engineering (Buckley), University of Delaware, Newark, DE, the Department of Orthopaedics & Rehabilitation (Dr. Lattanza), Yale School of Medicine, New Haven CT, and the Medical student contributor: Delaney Harbold, BS, The Pennsylvania State University College of Medicine. Correspondence to Dr. Lattanza: [email protected]. None of the following authors or any immediate family member has received anything of value from or has stock or stock options held in a commercial company or institution related directly or indirectly to the subject of this article: Buckley, Dearolf, and Dr. Lattanza

Ruth Jackson Orthopaedic Society: Promoting Women in Orthopaedics.

The Ruth Jackson Orthopaedic Society is the oldest organization in the world, supporting women in orthopaedic surgery. The mission is to promote the professional development of women in orthopaedics throughout all stages of their careers. Essential components of the strategic plan include collaboration, communication, and education, with specific domains including diversity and inclusion, professional development, membership, research, and organizational excellence. As of 2021, there are 1,161 members, with a large focus on mentorship and scholarship, providing multiple opportunities for members to excel in orthopaedics. At the core of the Ruth Jackson Orthopaedic Society is the commitment to one another, embracing the uniqueness of being a woman in orthopaedic surgery.

Current challenges for women in orthopaedics.

Orthopaedics has been left behind in the worldwide drive towards diversity and inclusion. In the UK, only 7% of orthopaedic consultants are female. There is growing evidence that diversity increases innovation as well as patient outcomes. This paper has reviewed the literature to identify some of the common issues affecting female surgeons in orthopaedics, and ways in which we can address them: there is a wealth of evidence documenting the differences in the journey of men and women towards a consultant role. We also look at lessons learned from research in the business sector and the military. The ‘Hidden Curriculum’ is out of date and needs to enter the 21st century: microaggressions in the workplace must be challenged; we need to consider more flexible training options and support trainees who wish to become pregnant; mentors, both male and female, are imperative to provide support for trainees. The world has changed, and we need to consider how we can improve diversity to stay relevant and effective.Cite this article: Bone Jt Open 2021;2-10:893–899.

Representation of Women in Academic Orthopaedic Leadership: Where Are We Now?

Women have long been underrepresented in orthopaedic surgery; however, there is a lack of quantitative data on the representation of women in orthopaedic academic program leadership. (1) What is the proportion of women in leadership roles in orthopaedic surgery departments and residency programs in the United States (specifically, chairs, vice chairs, program directors, assistant program directors, and subspecialty division chiefs)? (2) How do women and men leaders compare in terms of years in position in those roles, years in practice, academic rank, research productivity as represented by publications, and subspecialty breakdown? (3) Is there a difference between men and women in the chair or program director role in terms of whether they are working in that role at institutions where they attended medical school or completed their residency or fellowship? We identified 161 academic orthopaedic residency programs from the Accreditation Council for Graduate Medical Education (ACGME) website. Data (gender, length of time in position, length of time in practice, professorship appointment, research productivity as indirectly measured via PubMed publications, and subspecialty) were collected for chairs, vice chairs, program directors, assistant program directors, and subspecialty division chiefs in July 2020 to control for changes in leadership. Information not provided by the ACGME and PubMed was found using orthopaedic program websites and the specific leader's curriculum vitae. Complete data were obtained for chairs and program directors, but there were missing data points for vice chairs, assistant program directors, and division chiefs. All statistical analysis was performed using SPSS using independent t-tests for continuous variables and the Pearson chi-square test for categorical variables, with p < 0.05 considered significant. Three percent (4 of 153) of chairs, 8% (5 of 61) of vice chairs, 11% (18 of 161) of program directors, 27% (20 of 75) of assistant program directors, and 9% (45 of 514) of division chiefs were women. There were varying degrees of missing data points for vice chairs, assistant program directors, and division chiefs as not all programs reported or have those positions. Women chairs had fewer years in their position than men (2 ± 1 versus 9 ± 7 [95% confidence interval -9.3 to -5.9]; p < 0.001). Women vice chairs more commonly specialized in hand or tumor compared with men (40% [2 of 5] and 40% [2 of 5] versus 11% [6 of 56] and 4% [2 of 56], respectively; X2(9) = 16; p = 0.04). Women program directors more commonly specialized in tumor or hand compared with men (33% [6 of 18] and 17% [3 of 18] versus 6% [9 of 143] and 11% [16 of 143], respectively; X2(9) = 20; p = 0.02). Women assistant program directors had fewer years in practice (9 ± 4 years versus 14 ± 11 years [95% CI -10.5 to 1.6]; p = 0.045) and fewer publications (11 ± 7 versus 30 ± 48 [95% CI -32.9 to -5.8]; p = 0.01) than men. Women division chiefs had fewer years in practice and publications than men and were most prevalent in tumor and pediatrics (21% [10 of 48] and 16% [9 of 55], respectively) and least prevalent in spine and adult reconstruction (2% [1 of 60] and 1% [1 of 70], respectively) (X2(9) = 26; p = 0.001). Women program directors were more likely than men to stay at the same institution they studied at for medical school (39% [7 of 18] versus 14% [20 of 143]; odds ratio 3.9 [95% CI 1.4 to 11.3]; p = 0.02) and trained at for residency (61% [11 of 18] versus 42% [60 of 143]; OR 2.2 [95% CI 0.8 to 5.9]; p = 0.01). The higher percentage of women in junior leadership positions in orthopaedic surgery, with the data available, is a promising finding. Hand, tumor, and pediatrics appear to be orthopaedic subspecialties with a higher percentage of women. However, more improvement is needed to achieve gender parity in orthopaedics overall, and more information is needed in terms of publicly available information on gender representation in orthopaedic leadership. Proportional representation of women in orthopaedics is essential for quality musculoskeletal care, and proportional representation in leadership may help encourage women to apply to the specialty. Our findings suggest movement in an improving direction in this regard, though more progress is needed.

A Plausible Pipeline to Diversifying Orthopaedics: Premedical Programming

To determine whether premedical programming can address the interest level and perception of barriers to women in orthopaedics held by female high school and medical students. A thirteen-question paper-based survey was distributed among the high school and medical school participants prior to the January 2020 Perry Outreach Program and Medical Student Outreach Program. After a day of participation in mock procedures and speaker sessions, participants subsequently completed another survey of seven-questions. The Perry Outreach Program and Medical Student Outreach Program were conducted at the University of Alabama at Birmingham campus. Participants consisted of high school and medical school women hailing from the Birmingham metropolitan area, who had signed up for the Perry programs via email, outreach to local high schools, and social media interest pages. Participant sampling was stratified by race and level of education (high school vs. medical school). A total of 36 women, 18 high school and 18 medical school, attended the Perry Initiative events and responded to the pre-event and post-event surveys. Before the Perry Initiative programs, all participants felt women faced more barriers than men in pursuing a career in orthopaedics. Participation in the Perry Initiative event increased average interest in orthopaedics by 28% among high school and 11% among medical school students. Prior to the Perry Initiative, 31% percent of the total attendees reported knowing a female orthopaedist. The Perry Initiative improved perceptions of both high school and medical students regarding the ability of women to have a work/life balance, family life, and children during orthopaedics residency. Medical student participation in the events led to a decreased belief in barriers regarding schedule, family life, perceptions of an orthopaedic surgeon, and perceptions of peers within healthcare setting.

O44 Gender bias and sexual discrimination in orthopaedics: time for change

Abstract Introduction Gender bias and sexual discrimination (GBSD) have been widely recognized across a range of fields and are now part of the wider social consciousness. Such conduct can occur in the medical workplace, with detrimental effects on recipients. The aim of this review was to identify the prevalence and impact of GBSD in orthopaedic surgery, as well as mitigating strategies. Method A systematic review was conducted by searching Medline, EMCARE, CINAHL, PsycINFO, and the Cochrane Library Database. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. Original research papers pertaining to the prevalence and impact of GBSD, or mitigating strategies, within orthopaedics were reviewed. Result Of 570 papers, 27 were eligible for inclusion. These were published between 1998 and 2020. 13 papers discussed the prevalence of GBSD, 13 related to the impact of these behaviours, and six discussed mitigating strategies. GBSD was found to be common in the orthopaedic workplace, with all sources showing women to be the subjects. Effects include poor workforce representation, lower salaries, and less career success for women in orthopaedics. Mitigating strategies in the literature are focused on providing female role models, mentors, and educational interventions. Conclusion GBSD is common in orthopaedic surgery, with a substantial impact on sufferers. A small number of mitigating strategies have been tested but these are limited in their scope. As such, the orthopaedic community is obliged to participate in more thoughtful and proactive strategies that mitigate against GBSD, by improving female recruitment and retention within the specialty. Take-home Message Gender bias and sexual discrimination remain common within orthopaedics. The international orthopaedic community is obliged to do more to tackle this problem.

Does a Career in Orthopaedic Surgery Affect a Woman's Fertility?

Orthopaedic surgery lags behind other specialties in the recruitment of women. Concerns about fertility, pregnancy, and childbearing may be a deterrent to women when considering orthopaedic surgery as a specialty. An anonymous 168-item survey was distributed to the members of Ruth Jackson Orthopedic Society and the Women in Orthopaedics, an online group exclusive to female orthopaedic surgeons. Respondents were queried regarding family planning, contraceptive length of use, fertility, perinatal work habits, age and stage at each pregnancy, pregnancy complications, and miscarriages. Eight hundred one surveys were collected. Seven hundred fifty (94%) expressed interest in having children of their own, with 60% having at least one child at the time of the survey. The average maternal age at birth of the first child was 33.6 ± 3.6 years. Voluntary childlessness was reported by 6% (49/801) of survey respondents. Eighteen percent of this group stated that their choice as an orthopaedic surgeon served as a barrier to having children. Among those with children, childbearing was intentionally delayed by 53% because of their career choice (425/801). Fifty-two percent did not conceive their first child until the end of their training. Complications during pregnancy were reported among 24%. A total of 853 children were conceived by this cohort with assisted reproductive technology being used 106 times. Miscarriages were reported by 38% (304/801). Of those who miscarried, only 28% informed their employer and 8% took time off during or immediately after their miscarriage. Most respondents desire to have children but two-thirds delay doing so because of their career choice and its demands. Having a family is an important part of life for many orthopaedic surgeons, and our study provides an updated description of the fertility and pregnancy characteristics of female orthopaedic surgeons to help guide present and future surgeons in their family planning.

Women and men in orthopaedics.

Purpose: To compare and discuss the gender disparities in the Orthopaedic specialty. Methods: We reviewed the literature to find the rates of women applying for an orthopaedic residency, fellowship, and academic career program, to understand the causes of the disparities in women in orthopaedics, and how this relates to orthopaedic surgical practice. Results: The idea that men and women are different and have different working styles and skills and the belief that males are more dominant and more status-worthy than females leads to gender barriers and stereotypes that restrict women from entering male-dominated specialties. It is important to mention that equivalent barriers restrict men from pursuing female-dominated specialties such as Gynecology. Economic disparities and gender stereotypes that divide medical specialties into masculine and feminine, creating a gender gap in health care are major concerns. However, the number of women in the health sector is expected to increase due to the growing amount of female students that are expected to soon graduate. A leadership gender gap also exists; although women consist of 70% of the health care workforce they occupy only 25% of leadership positions. Conclusion: The existence of gender-based disparities in healthcare is multifactorial. The explanation behind the existence of a so-called gender gap lies in organizational and individual factors. Early development and family relations, the decision between work and life balance, personal choices and interests, as well as working conditions, absence of role models and mentorship and institutional policies make gender disparities even more evident.