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The gender distribution in intensive care units is consistently found to be around 60% men and 40% women. This might be medically sound. Our main purpose with this study was to investigate if physicians admit men and women to the intensive care unit equally. We sought to answer this question using a blinded randomized survey study. We used an online survey tool, with a hyperlink on European society of intensive care medicine webpage. Responders were randomized to either a critical care case Jane or a critical care case John , otherwise identical. The responders were asked if they would admit Jane/John to an intensive care unit, yes or no. Possible differences in admittance rate on the basis of the gender of the patient were analysed. In addition, we analysed if the gender of the responder affected admittance rate, regardless of the gender of the patient. 70.1% of the responders randomized to the John case opted to admit, vs. 68.3% of the responders randomized to the Jane case, p = 0.341. Regardless the gender of the patient, 70.1% of male responders opted to admit the patient, vs. 69.7% of female responders, p = 0.886. In this blinded randomized multicentre survey study, we could not demonstrate any difference in willingness to admit a patient to ICU, solely based on the gender of the patient. Patient gender as a factor for ICU admittance. A blinded randomized survey.

Stereotype threat is a situational threat in which a member of a stereotyped group fears conforming to a negative stereotype. In this study, we examined the impact of stereotype threat on surgical performance and working memory among surgical residents. Residents at one institution were randomized to either the threat condition or the no-threat condition. We administered the Vandenberg Mental Rotation Test and the reading span task to assess residents’ mental rotation and working memory, respectively. 102 residents participated in this study (response rate 61%). In multivariable analysis, we found significant gender differences. Men outperformed women in mental rotation, and women outperformed men in working memory. There was no effect of condition on performance on the mental rotation or working memory test. No effect of condition on either test suggests that high-achieving women may be less susceptible to stereotype threat. This could be due to self-selection or adapted resilience, or women in this context may be more qualified to reach the same level of achievement as their male colleagues. •Residents were randomized to a stereotype threat condition or a no-threat condition.•There was no condition effect on the residents' working memory or mental rotation.•We found a gender difference in mental rotation such that men outperformed women.•Women outperformed men on a working memory task regardless of condition. This study examined the impact of stereotype threat on surgical performance and working memory among surgical residents. Residents were randomized to a stereotype threat condition or a no-threat condition. We found gender differences in both mental rotation ability, such that men outperformed women, and in working memory, such that women outperformed men. There was no significant impact on women's performance in the threat condition.

The COVID-19 pandemic has heightened interest in how physician mental health can be protected and optimised, but uncertainty and misinformation remain about some key issues. In this Review, we discuss the current literature, which shows that despite what might be inferred during training, physicians are not immune to mental illness, with between a quarter and a third reporting increased symptoms of mental ill health. Physicians, particularly female physicians, are at an increased risk of suicide. An emerging consensus exists that some aspects of physician training, working conditions, and organisational support are unacceptable. Changes in medical training and health systems, and the additional strain of working through a pandemic, might have amplified these problems. A new evidence-informed framework for how individual and organisational interventions can be used in an integrated manner in medical schools, in health-care settings, and by professional colleagues is proposed. New initiatives are required at each of these levels, with an urgent need for organisational-level interventions, to better protect the mental health and wellbeing of physicians.

Women are under-represented in academic medicine. We reviewed the empirical evidence focusing on the reasons for women's choice or rejection of careers in academic medicine. Using a systematic search, we identified 52 studies published between 1985, and 2015. More than half had methodological limitations and most were from North America. Eight main themes were explored in these studies. There was consistent evidence for four of these themes: women are interested in teaching more than in research; participation in research can encourage women into academic medicine; women lack adequate mentors and role models; and women experience gender discrimination and bias. The evidence was conflicting on four themes: women are less interested in research than men; women lose commitment to research as their education and training progress; women are deterred from academic careers by financial considerations; and women are deterred by concerns about work–life balance. Inconsistency of findings across studies suggests significant opportunities to overcome barriers by providing a more enabling environment. We identified substantial gaps in the scientific literature that could form the focus of future research, including shifting the focus from individuals' career choices to the societal and organisational contexts and cultures within which those choices are made; extending the evidence base to include a wider range of countries and settings; and testing the efficacy of interventions.

Background Although women account for approximately half of the medical students in the United States, they represent only 13% of orthopaedic surgery residents and 4% of members of the American Academy of Orthopaedic Surgeons (AAOS). Furthermore, a smaller relative percentage of women pursue careers in orthopaedic surgery than in any other subspecialty. Formal investigations regarding the gender discrepancy in choice of orthopaedic surgery are lacking. Questions/purposes (1) What reasons do women orthopaedic surgeons cite for why they chose this specialty? (2) What perceptions do women orthopaedic surgeons think might deter other women from pursuing this field? (3) What role does early exposure to orthopaedics and mentorship play in this choice? (4) What professional and personal choices do women in orthopaedics make, and how might this inform students who are choosing a career path? Methods A 21-question survey was emailed to all active, candidate, and resident members of the Ruth Jackson Orthopaedic Society (RJOS, n = 556). RJOS is the oldest surgical women’s organization incorporated in the United States. An independent orthopaedic specialty society, RJOS supports leadership training, mentorship, grant opportunities, and advocacy for its members and promotes sex-related musculoskeletal research. Although not all women in orthopaedic practice or training belong to RJOS, it is estimated that 42% of women AAOS fellows are RJOS members. Questions were formulated to determine demographics, practice patterns, and lifestyle choices of women who chose orthopaedic surgery as a specialty. Specifically, we evaluated the respondents’ decisions about their careers and their opinions of why more women do not choose this field. For the purpose of this analysis, the influences and dissuaders were divided into three major categories: personal attributes, experience/exposure, and work/life considerations. Results The most common reasons cited for having chosen orthopaedic surgery were enjoyment of manual tasks (165 of 232 [71%]), professional satisfaction (125 of 232 [54%]), and intellectual stimulation (123 of 232 [53%]). The most common reasons indicated for why women might not choose orthopaedics included perceived inability to have a good work/life balance (182 of 232 [78%]), perception that too much physical strength is required (171 of 232 [74%]), and lack of strong mentorship in medical school or earlier (161 of 232 [69%]). Respondents frequently (29 of 45 [64%]) commented that their role models, mentors, and early exposure to musculoskeletal medicine were influential, but far fewer (62 of 231 [27%]) acknowledged these in their top five influences than they did the more “internal” motivators. Conclusions To our knowledge, this is the largest study of women orthopaedic surgeons regarding factors influencing their professional and personal choices. Our data suggest that the relatively few women currently practicing orthopaedics were attracted to the field because of their individual personal affinity for its nature despite the lack of role models and exposure. The latter factors may impact the continued paucity of women pursuing this field. Programs designed to improve mentorship and increase early exposure to orthopaedics and orthopaedic surgeons may increase personal interest in the field and will be important to attract a diverse group of trainees to our specialty in the future.

Limited data exist on differences in time spent on household activities and child care between male and female physicians, which may influence sex differences in hours worked professionally. We studied sex differences among married physicians in time spent on household activities (eg, cleaning and cooking) and child care (eg, bathing and homework) from 2003 through 2016 using the American Time Use Survey, a detailed time use survey administered by the US Census. Overall, we found that female physicians with children spent 100.2 minutes (95% CI, 67.0-133.3 minutes) more per day on household activities and child care than did male physicians, a finding that was qualitatively similar after adjustment for work hours outside the home of both spouses. These patterns may reflect societal norms that ultimately influence physician sex differences in hours worked professionally.

Background Orthopaedic surgery now has the lowest percentage of women in residency programs of any surgical specialty. Understanding factors, particularly those related to the medical school experience, that contribute to the specialty’s inability to draw from the best women students is crucial to improving diversity in the profession. Questions/purposes (1) Does required medical school exposure to orthopaedic surgery increase the proportion of women choosing the specialty? (2) Do negative perceptions deter women from choosing orthopaedic surgery? (3) What proportion of orthopaedic faculty members are women, and what proportion of residents are women? (4) To what degree has gender bias been identified in the application/interview process? Methods Two PubMed searches of articles between 2005 and 2015 were performed using a combination of medical subject headings. The first search combined “Orthopaedics” with “Physicians, women” and phrases “women surgeons” or “female surgeons” and the second combined “Orthopedics” with “Internship & Residency” or “exp Education, Medical” and “Sex Ratio” or “Sex Factors”, resulting in 46 publications of which all abstracts were reviewed resulting in 11 manuscripts that were related to the research questions. The Google Scholar search of “women in orthopaedic surgery” identified one additional publication. These 12 manuscripts were read and bibliographies of each reviewed with two additional publications identified and included. Results Required exposure to orthopaedics was found to be positively associated with the number of women applicants to the field, whereas negative perceptions have been reported to deter women from choosing orthopaedic surgery. Orthopaedics has the lowest percentage of women faculty and women residents (14%) compared with other specialties; this suggests that same gender mentorship opportunities are limited. For women applying to orthopaedics, gender bias is most evident through illegal interview questions, in which women are asked such questions more often than men (such as family planning questions, asked to 61% of women versus 8% of men). Conclusions Successful recruitment of women to orthopaedic surgery may be improved by early exposure and access to role models, both of which will help women students’ perceptions of their role in field of orthopaedic surgery.

Background Orthopaedic surgery lags behind other surgical specialties in terms of gender diversity. The percentage of women entering orthopaedic residency persistently remains at 14% despite near equal ratios of women to men in medical school classes. This trend has been attributed to negative perceptions among women medical students of workplace culture and lifestyle in orthopaedics as well as lack of exposure, particularly during medical school when most women decide to enter the field. Since 2012, The Perry Initiative, a nonprofit organization that is focused on recruiting and retaining women in orthopaedics, had conducted extracurricular outreach programs for first- and second-year female medical students to provide exposure and mentoring opportunities specific to orthopaedics. This program, called the Medical Student Outreach Program (MSOP), is ongoing at medical centers nationwide and has reached over 300 medical students in its first 3 program years (2012–2014). Questions/purposes (1) What percentage of MSOP participants eventually match into orthopaedic surgery residency? (2) Does MSOP impact participants’ perceptions of the orthopaedics profession as well as intellectual interest in the field? Methods The percentage of program alumnae who matched into orthopaedics was determined by annual followup for our first two cohorts who graduated from medical school. All program participants completed a survey immediately before and after the program that assessed the impact of MSOP on the student’s intention to pursue orthopaedics as well as perceptions of the field and intellectual interest in the discipline. Results The orthopaedic surgery match rate for program participants was 31% in our first graduating class (five of 16 participants in 2015) and 28% in our second class (20 of 72 participants in 2016). Pre/post program comparisons showed that the MSOP influenced students’ perceptions of the orthopaedics profession as well as overall intellectual interest in the field. Conclusions The results of our study suggest that The Perry Initiative’s MSOP positively influences women to choose orthopaedic surgery as a profession. The match rate for program alumnae is twice the percentage of females in current orthopaedic residency classes. Given these positive results, MSOP can serve as a model, both in its curricular content and logistic framework, for other diversity initiatives in the field.

The Implicit Association Test (IAT) is a validated tool used to measure implicit biases, which are mental associations shaped by one's environment that influence interactions with others. Direct evidence of implicit gender biases about women in medicine has yet not been reported, but existing evidence is suggestive of subtle or hidden biases that affect women in medicine. To use data from IATs to assess (1) how health care professionals associate men and women with career and family and (2) how surgeons associate men and women with surgery and family medicine. This data review and cross-sectional study collected data from January 1, 2006, through December 31, 2017, from self-identified health care professionals taking the Gender-Career IAT hosted by Project Implicit to explore bias among self-identified health care professionals. A novel Gender-Specialty IAT was also tested at a national surgical meeting in October 2017. All health care professionals who completed the Gender-Career IAT were eligible for the first analysis. Surgeons of any age, gender, title, and country of origin at the meeting were eligible to participate in the second analysis. Data were analyzed from January 1, 2018, through March 31, 2019. Measure of implicit bias derived from reaction times on the IATs and a measure of explicit bias asked directly to participants. Almost 1 million IAT records from Project Implicit were reviewed, and 131 surgeons (64.9% men; mean [SD] age, 42.3 [11.5] years) were recruited to complete the Gender-Specialty IAT. Healthcare professionals (n = 42 991; 82.0% women; mean [SD] age, 32.7 [11.8] years) held implicit (mean [SD] D score, 0.41 [0.36]; Cohen d = 1.14) and explicit (mean [SD], 1.43 [1.85]; Cohen d = 0.77) biases associating men with career and women with family. Similarly, surgeons implicitly (mean [SD] D score, 0.28 [0.37]; Cohen d = 0.76) and explicitly (men: mean [SD], 1.27 [0.39]; Cohen d = 0.93; women: mean [SD], 0.73 [0.35]; Cohen d = 0.53) associated men with surgery and women with family medicine. There was broad evidence of consensus across social groups in implicit and explicit biases with one exception. Women in healthcare (mean [SD], 1.43 [1.86]; Cohen d = 0.77) and surgery (mean [SD], 0.73 [0.35]; Cohen d = 0.53) were less likely than men to explicitly associate men with career (B coefficient, -0.10; 95% CI, -0.15 to -0.04; P < .001) and surgery (B coefficient, -0.67; 95% CI, -1.21 to -0.13; P = .001) and women with family and family medicine. The main contribution of this work is an estimate of the extent of implicit gender bias within surgery. On both the Gender-Career IAT and the novel Gender-Specialty IAT, respondents had a tendency to associate men with career and surgery and women with family and family medicine. Awareness of the existence of implicit biases is an important first step toward minimizing their potential effect.

Discrimination faced by Asian American trainees in medical school include those reported by female trainees. This study aims to characterize the microaggressions faced by Asian American woman medical students. We use a mixed methods approach to characterize the experiences of Asian Americans in United States (US) medical schools through an anonymous online survey and participation in focus groups. Among our 305 participants, 65.9 ​% were women. More women experienced microaggressions than men (p ​< ​0.001). Compared to men, women reported significantly higher rates of supervisors having higher expectations of them, implying they were submissive, and describing them as too quiet. Women felt that their experiences with microaggressions were entangled with being Asian and a woman, but could not distinguish which identity was being targeted. The intersectionality of being Asian American and a woman in medical training has not been explored. We found that this duality intensified experiences of microaggressions. •Asian American women experience more microaggression than Asian American men.•It is unclear if microaggressions are targeted at their race and/or gender.•Asian American women are more uncomfortable reporting discrimination than men.•Recognizing the role of intersectionality can guide effective institutional changes.