Medical Student Perceptions of the Barriers to Entering Orthopaedic Surgery Differ by Gender.

BACKGROUND

The value of gender representation has been increasingly recognised in medicine, yet women represent only 13.6% of orthopaedic surgeons in Canada. The primary objective of this study was to determine barriers identified by medical students considering pursuing a career in orthopaedic surgery. The secondary objective was to assess for gender-based differences in barriers identified by medical students.

METHODS

A cross-sectional mixed-methods survey was distributed to final-year students at a Canadian medical school. Descriptive analyses were calculated for the study population and gender subgroups. To compare responses between gender subgroups, chi-square or Fisher's exact tests were employed for binary data, and non-parametric Mann-Whitney U tests for ordinal data. Open-text responses were reviewed for descriptions of students' experiences in orthopaedics.

RESULTS

Sixty-four medical students participated, representing a response rate of 59.3%. Male culture and the need for physical strength were identified as strong barriers to pursuing a career in orthopaedics. Additionally, women reported less exposure (p = 0.003), disproportionate constraints (i.e., scrutiny of performance based on gender, p = 0.001), less mentorship (p = 0.028), more concerns about verbal (p < 0.001) and sexual abuse (p = 0.013), and higher rates of direct discouragement from pursuing orthopaedics than men (p = 0.035). Open-text responses indicated that orthopaedics was not considered welcoming to all medical students.

CONCLUSIONS

This study is the first to characterise medical student perceptions of barriers to gender equity in orthopaedic surgery in Canada. Fostering a more equitable environment will necessitate a paradigm shift in the educational framework toward orthopaedic surgery.