Barnes K Lauren, McGuire Lauren, Dunivan Gena, Sussman Andrew L, McKee Rohini
Division of Urogynecology, Department of Obstetrics and Gynecology, University of New Mexico Health Science Center, Albuquerque, New Mexico.
University of New Mexico School of Medicine, Albuquerque, New Mexico.
J Surg Educ. 2019 Nov-Dec;76(6):e1-e14. doi: 10.1016/j.jsurg.2019.07.024. Epub 2019 Oct 7.
Medical schools now average approximately 50% female students, yet a disproportionate number of women continue to choose nonsurgical over surgical specialties. Once in training, studies indicate that pervasive gender stereotypes, sexism and harassment negatively affect female surgeons. The aim of this study is to describe female surgeons' experiences with gender bias and microaggressions in the workplace during residency and fellowship training, and understand if differences exist in the experiences of trainees in male-dominant vs female-dominant surgical specialties.
A mixed methods approach was used to explore the experiences of female surgical trainees. Participants were recruited from all surgical disciplines at an academic center. Initially, focus groups were used to explore themes that trainees face related to gender bias. A trained moderator conducted all focus groups, which were audio recorded and transcribed. Qualitative analysis of de-identified transcripts was performed to identify emerging themes. We then created an online survey using the validated 44-question Sexist Microaggression Experiences and Stress Scale to assess frequency and psychologic impact of these events with additional questions developed from the focus groups. The survey was sent to all female residents and fellows at one academic institution.
University of New Mexico Hospital, a tertiary care academic medical center.
Fifteen female surgical trainees participated in focus groups. Thirty-three female surgical trainees participated in the online survey.
Two focus groups including 15 female trainees were conducted, revealing 4 themes: Exclusion, Adaptation, Increased effort, and Development of Resilience Strategies. All participants had experienced gender bias or discrimination during medical school or surgical training. The quantitative survey had a 66% response rate (33/50 female trainees). Significant differences were found in the experience of female trainees in male-dominant vs female-dominant specialties, with those in male-dominant fields often reporting more frequent, severe, and stressful microaggression experiences. When describing how gender bias would affect their future in medicine, trainees in male-dominant specialties were more likely to report that due to gender bias, they "may leave medicine/retire early" (33% vs 6%, p = 0.040) and that they "would not recommend my profession to trainees or family members" (40% vs 6%, p = 0.015)."
Female surgical trainees continue to experience gender bias. A culture of sexism leads to physical and social adaptations to fit into the role of surgeon. Participants expressed significant effort to sustain this level of adaptation, leading to fatigue and creation of resilience mechanisms. The environment in which a trainee operates (male-dominant vs female-dominant) significantly impacts their experience. Those experiencing more bias were less likely to recommend their specialty and reported plans to leave medicine earlier. Culture change across institutions and system-level interventions are necessary to create meaningful and sustainable change that improves the experience of female surgical trainees.
医学院校目前女生平均约占50%，然而，选择非外科专业而非外科专业的女性比例却过高。研究表明，一旦进入培训阶段，普遍存在的性别刻板印象、性别歧视和骚扰会对女外科医生产生负面影响。本研究的目的是描述女外科医生在住院医师和专科医师培训期间在工作场所遭遇性别偏见和微侵犯的经历，并了解在男性主导与女性主导的外科专业中，受训人员的经历是否存在差异。
采用混合方法来探究女外科受训人员的经历。参与者从一个学术中心的所有外科专业中招募。最初，通过焦点小组来探究受训人员面临的与性别偏见相关的主题。由一名经过培训的主持人主持所有焦点小组讨论，并进行录音和转录。对经过身份识别处理的转录文本进行定性分析，以确定新出现的主题。然后，我们使用经过验证的44个问题的《性别歧视微侵犯经历与压力量表》创建了一项在线调查，以评估这些事件的发生频率和心理影响，并从焦点小组讨论中提出了其他问题。该调查发送给了一所学术机构的所有女性住院医师和专科医师。
新墨西哥大学医院，一家三级医疗学术医学中心。
15名女外科受训人员参加了焦点小组讨论。33名女外科受训人员参加了在线调查。
进行了两个焦点小组讨论，包括15名女受训人员，揭示了4个主题：被排斥、适应、加倍努力和制定恢复力策略。所有参与者在医学院或外科培训期间都经历过性别偏见或歧视。定量调查的回复率为66%（33/50名女受训人员）。在男性主导与女性主导专业的女受训人员经历方面发现了显著差异，男性主导领域的受训人员经常报告更频繁、更严重且压力更大的微侵犯经历。当描述性别偏见将如何影响她们在医学领域的未来时，男性主导专业的受训人员更有可能报告说，由于性别偏见他们“可能会离开医学领域/提前退休”（33%对6%，p = 0.040），以及“不会向受训人员或家庭成员推荐我的职业”（40%对6%，p = 0.015）。
女外科受训人员继续经历性别偏见。性别歧视文化导致她们在身体和社交方面进行调整以适应外科医生的角色。参与者表示为维持这种适应水平付出了巨大努力，导致疲劳并形成了恢复力机制。受训人员所处的环境（男性主导与女性主导）对她们的经历有重大影响。那些经历更多偏见的人不太可能推荐自己的专业，并报告有提前离开医学领域的计划。跨机构的文化变革和系统层面的干预措施对于创造有意义且可持续的变革、改善女外科受训人员的经历是必要的。
