What makes women abandon their dreams of becoming surgeons?

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Women make up just 11% of consultant surgeons, yet 60% of medical students are female. New research by Gold Coast Health general surgeon Dr Rhea Liang now provides insights into why so many women walk away from their surgical training.

Dr. Liang said through her 16 years in the profession, she was disappointed to see her female counterparts leaving the profession. Prompted by this her research reflected on why surgery was a male-dominated profession. Dr. Liang was assisted by Professor Debra Nestel of Melbourne University and Professor Tim Dornan, of Queens University Belfast, UK. Their qualitative research paper, “Why do women leave surgical training? A qualitative and feminist study”, was published this month in The Lancet.

The study asked women to describe in-depth why they had chosen to leave surgical training soon after they had started it, despite having aspired to the profession since childhood.

“We know that women leave advanced surgical training at twice the rate of their male counterparts. I wanted to hear women’s stories. I wanted to know what we can do as an industry to improve gender equality and diversity across the board. We also know from research that improving culture and diversity for surgeons leads to better professional behaviours, more empathy for our patients and in turn improves patient outcomes,” she said.

The research confirmed factors identified in earlier reports as reasons women leave surgical training, and contributed six new factors: unavailability of leave, a distinction between valid and "invalid" reasons for leave, poor mental health, absence of interactions with other women in surgery, fear of repercussion, and lack of pathways for independent and specific support.

"They leave because of various stresses, which accumulate like a tower of stacked blocks. Eventually, an individual's tower can reach a height that it will topple in the absence of efforts to stabilise it, often the final 'toppling' precipitator appearing relatively minor," Dr. Liang said.

The research also found that by analysing “leavers'” experiences in depth, it was possible to see how these factors discriminated selectively against women.

"Our findings suggest that women might be better helped by interventions that do not focus unduly on gender. These interventions are likely to improve surgical training for both women and men because many factors, such as long working hours and unpredictable lifestyle affect all trainees, and changing societal expectations mean that previously female factors, such as childrearing, are increasingly shared," Dr. Liang said.

Dr. Liang is also Deputy Chair of the RACS Operating with Respect Committee, which looks at how cultural change can be effected in the surgical workforce. "I am fortunate to have a role with RACS to reshape the culture of surgery on the foundations of collaboration and respect. This also means dealing with unacceptable behaviours as we strengthen surgical education and training. It is not going to be a quick fix and we know this is a long-term investment and that we need to start somewhere," she said.

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