Department of Orthopaedics, Rutgers University New Jersey Medical School, Newark, NJ, USA.
Clin Orthop Relat Res. 2024 Aug 1;482(8):1351-1357. doi: 10.1097/CORR.0000000000003070. Epub 2024 Apr 16.
Women remain underrepresented in leadership roles, faculty roles, and among residents in orthopaedic surgery. It has been suggested that having women in leadership positions in orthopaedic surgery may help to increase the gender diversity of residency programs. However, to our knowledge, no study has explored the relationship, if any, between the gender of the residency program director and the percentage of women in the residency program.
QUESTIONS/PURPOSES: (1) Is the program director's gender associated with differences in the percentage of women orthopaedic surgery residents? (2) Do women and men differ in the time to appointment of program director?
A list of 207 orthopaedic surgery residencies was obtained from the Accreditation Council for Graduate Medical Education (ACGME) website for the academic year 2021 to 2022. The study excluded 6% (13) of programs; 4% (8) were those without ACGME accreditation and those with initial accreditation, and 2% (5) did not have updated 2021 to 2022 resident lists. Descriptive information on 194 programs was obtained from publicly accessible resources from July 2021 through July 2022. The institution's website and the American Medical Association's (AMA) Fellowship and Residency Electronic Interactive Database (FREIDA) was used to collect residency program characteristics and resident demographics [ 2 ]. Doximity, Healthgrades, and LinkedIn were used to further collect current orthopaedic surgery residency program director demographics, including gender, age, and education/training history. To determine gender, photographs and pronouns (she/her/hers or he/him/hers) used in their biographies were used first. To confirm this, secondary sources were used including their NPI profile, which lists gender; Doximity; and their LinkedIn profile. Scopus was used to analyze research output by the program directors-using the Hirsch index (h-index) as the primary bibliometric metric. A total of 194 program directors were identified, of whom of 12% (23) were women and 88% (171) were men. Of the 4421 total residents among these programs, 20% (887) were women and 80% (3534) were men. A univariate analysis comparing program directors was conducted, with continuous variables analyzed using an independent-sample t-test and categorical variables analyzed using a Pearson chi-square test. With the numbers available, a post hoc statistical power calculation indicated that we could detect an 32% difference in the percentage of women in a program as significant with 80% power at the p < 0.05 level, whereas we might have been underpowered to discern smaller differences than that.
With the numbers available, we found no difference in the percentage of women in residency programs run by women program directors than in programs in which the program director was a man (22% [125 of 558] versus 20% [762 of 3863], mean difference 2% [95% CI -1.24% to 7.58%]; p = 0.08). Comparing women to men program directors, women had fewer years between residency completion and appointment to the position of program director (8 ± 2 years versus 12 ± 7 years, mean difference 4 years [95% CI 2.01 to 7.93 years]; p = 0.02) and had a lower mean h-index (7 ± 4 versus 11 ± 11, mean difference 4 [95% CI 1.70 to 6.56]; p = 0.03) and number of publications (24 ± 23 versus 41 ± 62, mean difference 17 [95% CI 3.98 to 31.05]; p = 0.01), although they did not differ in terms of their advanced degrees, duration of training, or likelihood of having taken a fellowship.
Orthopaedic residency programs that were run by women did not contain a higher percentage of women residents, suggesting that the gender of the individual in that role may not be as important as has been speculated by others. Future studies should investigate the intersectionality of gender, race, and ethnicity of residents, program directors, and current faculty.
The fact that women were placed in program director roles earlier in career may also carry special jeopardy for them. Those roles are difficult and can impair a faculty member's ability to conduct individual research, which often is key to further academic promotions. Given that and the fact that the gender of the program director was not associated with differences in gender composition of residency programs, we believe that increasing mentorship and access to pipeline programs will help promote diversity in residency programs.
女性在骨科手术领域的领导职位、教职岗位和住院医师中仍然代表性不足。有人认为，让女性担任骨科手术领域的领导职位可能有助于增加住院医师项目的性别多样性。然而，据我们所知，尚无研究探讨住院医师项目主任的性别与住院医师项目中女性的百分比之间是否存在任何关系。
问题/目的：（1）项目主任的性别是否与女性骨科手术住院医师的百分比存在差异有关？（2）女性和男性在担任项目主任的时间上是否存在差异？
从 2021 年至 2022 年的研究生医学教育认证委员会（ACGME）网站获得了 207 个骨科住院医师培训计划的名单。该研究排除了 6%（13 个）的项目；4%（8 个）为没有 ACGME 认证和初始认证的项目，2%（5 个）没有更新的 2021 年至 2022 年住院医师名单。2021 年 7 月至 2022 年 7 月期间，通过公开可获取的资源获取了 194 个项目的描述性信息。使用机构网站和美国医学协会（AMA）的住院医师和研究员电子交互式数据库（FREIDA）收集住院医师项目特征和住院医师人口统计学信息[2]。Doximity、Healthgrades 和 LinkedIn 用于进一步收集当前骨科住院医师培训项目主任的人口统计学信息，包括性别、年龄和教育/培训历史。为了确定性别，首先使用他们传记中的照片和代词（她/她/她的或他/他/他的）。为了确认这一点，使用了次要来源，包括他们的 NPI 档案，其中列出了性别；Doximity；和他们的 LinkedIn 档案。Scopus 用于分析项目主任的研究成果-使用 Hirsch 指数（h-index）作为主要的文献计量指标。确定了 194 名项目主任，其中 12%（23 人）为女性，88%（171 人）为男性。在这些项目中，共有 4421 名住院医师，其中 20%（887 人）为女性，80%（3534 人）为男性。对项目主任进行了单变量分析，连续变量采用独立样本 t 检验分析，分类变量采用 Pearson 卡方检验分析。根据现有的数据，我们进行了事后统计功效计算，表明我们可以在 80%的功效水平下检测到项目中女性比例差异 32%的显著差异，而我们可能没有足够的能力来辨别比这更小的差异。
根据现有的数据，我们发现女性项目主任领导的住院医师项目中女性的比例与男性项目主任领导的项目中女性的比例没有差异（22%[125/558]与 20%[762/3863]，平均差异 2%[95%置信区间-1.24%至 7.58%]；p=0.08）。与女性项目主任相比，男性项目主任在完成住院医师培训到担任项目主任的时间间隔更短（8±2 年与 12±7 年，平均差异 4 年[95%置信区间 2.01 至 7.93 年]；p=0.02），且 h-index 较低（7±4 与 11±11，平均差异 4[95%置信区间 1.70 至 6.56]；p=0.03），发表的文章数量较少（24±23 与 41±62，平均差异 17[95%置信区间 3.98 至 31.05]；p=0.01），尽管他们在高级学位、培训时间和是否参加过奖学金方面没有差异。
由女性领导的骨科住院医师培训项目中女性住院医师的比例没有更高，这表明该职位中个体的性别可能不如其他人推测的那么重要。未来的研究应调查住院医师、项目主任和现任教师的性别、种族和族裔的交叉性。
女性在职业早期担任项目主任的可能性更高，这也可能对她们造成特殊的风险。这些角色是困难的，可能会损害教职员工进行个人研究的能力，而这通常是进一步学术晋升的关键。考虑到这一点，以及项目主任的性别与住院医师项目的性别构成没有关系，我们认为增加指导和获得管道项目将有助于促进住院医师项目的多样性。
