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Why do women leave surgical training?

23 September 2019 | Avant media

These days, women only make up 13% of active surgeons in Australia and New Zealand. This is a particularly perplexing statistic, given men and women have graduated from medical school in approximately equal proportions, for at least 15 years.

Associate Professor Rhea Liang, a general and breast surgeon on the Gold Coast, surgical educator and advocate for women in surgery, made this conundrum the subject of her master’s research project, ‘Why do women leave surgical training? A qualitative and feminist study,’ recently published in The Lancet.

The study uncovered some stunning results, but paradoxically, has also elicited more questions according to A/Prof Liang.

“A lot of people have approached me and asked about Indigenous and Maori people in surgery, people of diverse gender and sexuality in surgery, and about people who live in rural settings or come from less socially advantaged backgrounds,” she says. “I am now driven to look a bit further”.

Next, she aims to apply novel research techniques to further examine what she describes as this “proven stubborn topic area”.

“To capture the full phenomenon, the total complexity of it, you really have to look at it through qualitative methods, which medicine has been rather slow to take up,” she explains.

The Avant Foundation has announced it will fund this next step of her research.

Game-changing findings

Keen to see a surgeon workforce as diverse as the community it serves, A/Prof Liang knew the reasons for the gender disparity were not well researched or understood.

Her research began with a review of existing literature and data in both Australasia and overseas. Then, she asked women from five medical specialties in Australia and New Zealand why they had left surgical training? What they told her formed the basis of some surprising results.

The danger of affirmative action

She discovered that gender-based affirmative action framed within a male-dominated institutional structure, actually sustained or exaggerated the very situations they were aiming to improve.

Or as A/Prof Liang puts it, “in surgery, we found that women who were already in the minority, felt even more so.”

In the surgical profession, she found women distanced themselves from support networks. When you are working in a specialty where 87% are male, support is very important, she says.

The Lancet study showed participants expressed concern that interventions specifically for women implied that women required special or additional treatment, amplifying differences between genders and implying that women were not as able as men,” A/Prof Liang says.

A threshold effect

The study identified the visual analogue of a tower of blocks that represent factors contributing to women’s decisions to leave surgical training.

“There is a threshold effect after three to four blocks, with the last block causing the entire tower to fall,” she says.

Beyond single-factor interventions

The next phase of her research will begin later this year, delving deeper into the factors contributing to the low proportion of women and other under-represented groups in surgery, and ways to address it.

Broadly, she believes surgery needs to improve institutional environments to support diversity in the profession.

She says this could pertain to fair rosters or support for surgeons’ family commitments, through to measures to avoid burnout and promote respectful behaviours.

Results from the next phase of the study are expected later this year.

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