Background
While the percentage of women admitted to medical colleges across India has gradually increased over the years to reach a current level of 51% [1], Surgery has mainly remained a male dominated field. Orthopedics, commonly referred to as an “old boys club”, has only 4% of female Orthopedic surgeons in the US [2]. The number of female Orthopedic surgeons in India is even fewer, trending at only 1% [3].
Studies have shown that female delivery of care is more patient centered, adheres more closely to guidelines and involves superior communication [4] as compared to care by male doctors. In addition, while consultations with female doctors have been shown to be equally satisfying for both male and female patients [5], female patients are more likely to prefer female doctors [5] which may be an important factor in the access of care. A 2018 study [6] also found that patients have better outcomes when there is gender concordance between the patient and the physician, and women suffering from an MI had higher mortality when treated by male doctors but this effect was attenuated when the male doctors work with female colleagues. This highlights the importance of increasing the number of practicing female orthopedic surgeons.
While other studies have been done on female Orthopedic surgeons [7] and on medical students abroad [8, 9] asking them about the possible reasons female medical students are unlikely to consider Orthopedics as a specialization—to our knowledge no similar study has been done in India. This study seeks to address the lack of information on the topic in India and find the possible causes for the lack of Female Orthopedic Surgeons by examining the perception of Orthopedics as a specialty at the root of the problem—undergraduate medical students.
Materials and Methods
The possible causes for low numbers of females in Orthopedic surgery were identified after a survey of literature and a questionnaire was created to assess these causes, as well as the general perception of Orthopedics among undergraduate medical students. The questionnaire contained 3 demographic questions, 1 question on willingness to take Orthopedics, 17 questions on perception of Orthopedics which were divided into 5 categories including- General Perceptions regarding Orthopedics, Personal Attributes required to become an Orthopedic surgeon, Experience and Exposure to Orthopedics, Work and Lifestyle Considerations, and Opportunities for Women in Orthopedics and 1 open question- “Do you think that there any other causes for low prevalence of female orthopedic surgeons?”.
The questionnaire consisted of three pages, with the first page enquiring about informed consent, the second page comprising three questions, and the last page containing 19 questions. Informed consent was mandatory to progress to the 2nd and 3rd pages of the questionnaire.
The questionnaire was first pilot tested on 5% of the study population i.e. 40 students to ensure clarity and comprehensiveness of the questions. Changes were made in response to feedback received from the pilot study. The questionnaire was then sent to 800 medical students of all ages enrolled at a tertiary care teaching hospital of Kolkata India, including 244 females and 556 males via the platform of google forms. Female orthopedists and consultants were not included in the study population as at the time of data collection the hospital had no women orthopedists.
Informed consent was taken from all participants and they were made aware of the length of the survey, the time it would take to complete the survey, and the names and contact details of the researchers performing the study and under whose guidance the study was performed. The participants were also informed about the purpose of the survey. No personal data was collected from the participants and no monetary or non-monetary incentives were offered for participating.
The survey was a closed survey and was advertised in the official class whatsapp groups of the students of the medical college. Google login was required before participation and duplicate responses were prevented by allowing only one submission per Google login. No IP addresses or cookies were used to identify a unique visitor as this feature was not available on Google Forms.
The responses were recorded and the possible answers were “Agree”, “Neutral” and “Disagree”. No adaptive questions were used as all questions apart from the last open question were compulsory. Data was collected over a period of one month from 25th September 2020 to 25th October 2020.
The exclusion criteria included those who did not provide informed consent. Incomplete questionnaire responses in which the open question was not answered but all others were answered were also analyzed. Respondents were not able to edit their responses after submission.
The data was then tabulated, expressed as percentages and analyzed by the authors using SPSS version 16.0 and Chi-squared test for significance. The possibility of confounding was investigated using stratification with Mantel–Haenszel test. A p value of < 0.05 was taken to indicate statistical significance.
Results
411 responses were obtained from 800 male and female medical students of all classes, leading to a response rate of 51.4%. Almost an equal number of men and women participated in the study, as can be seen from Table 1. The respondents had a mean age of 21.5 years, standard deviation of 1.651 and range of 18–27 years.
Table 1.
Sociodemographic parameters of the study population (N = 411)
| Sociodemographic parameter | ||
|---|---|---|
| Age(in completed years) | ||
| Mean | 21.5 | |
| Standard Deviation | 1.651 | |
| Range | 18 to 27 | |
| Gender | ||
| Male | 203 | 49.4% |
| Female | 208 | 50.6% |
| Year of study | ||
| First year | 90 | 21.9% |
| Second year | 71 | 17.3% |
| Third year | 94 | 22.9% |
| Final year | 101 | 24.6% |
| Intern | 55 | 13.4% |
Maximum participation was obtained from the final year students who contributed 24.6% of responses, while minimum from the interns- only 13.4% of responses.
35% of participants said that they would opt for orthopedics, given the choice (Table 2). This included a maximum of 43.6% students from internship year, and a minimum of 28.2% students in the second year, as can be seen in Fig. 1. 32.2%, 39.4%, and 34.7% of first year, third year and final year students, respectively also wanted to specialize in orthopedics (Fig. 1). Less number of females said they would opt for orthopedics, as compared to the male students: 26.0% of female students and 44.8% of male students (Fig. 2).
Table 2.
Table showing distribution of study population according to their choice of adopting Orthopedics as a future career option(N = 411)
| Preference | Number (N) | Percentage (%) |
|---|---|---|
| Yes | 145 | 35.3 |
| No | 266 | 64.7 |
Fig. 1.
Component bar diagram showing year-wise distribution of the population (N = 411) according to their willingness to choose orthopedics as a specialty
Fig. 2.
Component bar diagram showing whether or not the study population (N = 411) would choose Orthopedics according to the distribution based on sex of the population
Those who had been exposed to either theory classes in Orthopedics (3rd year, Final year students and Interns) were considered to have theoretical exposure to Orthopedics, while those who had been exposed to either ward classes or Orthopedics rotation (final year and interns) were considered to have clinical exposure to the subject.
The study population was stratified into theoretically or clinically exposed and non-exposed cohorts and the Mantel–Haenszel formula was applied to control confounding. The adjusted odds ratio showed men were 2.27 times more likely to opt for Orthopedics than females. (ORMH = 2.27, ORcrude = 2.32, magnitude of confounding was 23%). Gender was found to be significantly associated with willingness to take Orthopedics (p value of 0.000062, and an adjusted p value of 0.00016 after stratification) when a 95% Confidence Interval was taken, as can be observed from Table 3.
Table 3.
Table showing the Association of Preference for Orthopedics as a career with other parameters
| Co-variable | Group | Preference for Orthopedics as a career | Chi square | P value | Odds ratio | ||
|---|---|---|---|---|---|---|---|
| Yes (n,%) | No (n,%) | Total (n,%) | |||||
| Age | Above mean age (> = 21.5) | 75(34.9) | 140(65.1) | 215(52.3) | 0.03 | 0.8603 | 0.96 |
| Below mean age(< 21.5) | 70(35.7) | 126(64.3) | 196(47.7) | 1 | |||
| Clinical exposure | Clinically or theoretically exposed | 96(38.4) | 154(61.6) | 250(60.8) | 2.72 | 0.099026 | 1.42 |
| Not Clinically or theoretically exposed | 49(30.4) | 112(69.6) | 161(31.2) | 1 | |||
| Gender | Male | 91(44.8) | 112(55.2) | 203(49.4) | 16.01 (Adjusted Chi square- 14.25) | 0.000062 (PMH = 0.000160) | 2.32 (ORMH = 2.27) |
| Female | 54(26.0) | 154(74.0) | 208(50.6) | 1 | |||
In our questionnaire “Agree” was considered to show a negative perception towards Orthopedics.
Interestingly, more percentage of females answered “Agree” for nearly every question when compared to males, showing the negative perception of Orthopedics is higher in females. This was especially seen in the Opportunities for women in Orthopedics category, in the question “Patients are less likely to visit female orthopedists” with 42.4% of males and 67.3% of females agreeing to the above- a 24.9% difference.
As seen in Fig. 3, the top 3 negative perceptions of orthopedics among women were- “Orthopedics is considered socially to be more suited for men” (75.0%), “There is a lack of female role models in this field.” (75.0%) and “There is insufficient exposure to Orthopedics at an undergraduate level” (70.2%) while among men the top 3 negative perceptions were “There is insufficient exposure to Orthopedics at an undergraduate level” (67.5%), “There is a lack of female role models in this field” (67.5%) and “Orthopedic surgeries are long and require high stamina.” (65.0%).
Fig. 3.
Horizontal bar chart comparing the negative perceptions of orthopedics as a career in men and women (where “Agree” was considered to show a negative perception of Orthopedics)
In response to the open question, multiple respondents suggested that the low number of women opting for Orthopedics was due to the “high number of women who opted for female dominated streams such as Gynaecology”, “lack of family support”, “discouragement from both peers and Professors” and “Conventional way of thinking.”
Perceptions of Male and Female medical students about Orthopedics were compared and assessed for statistical significance by Chi Square test, as can be seen in Table 4. A significantly higher number of women than men thought that “Orthopedics requires high physical strength.”, “A very high IQ is required to specialise in Orthopedics.”. “An interest in sports is required to enjoy Orthopedics.”, “There is a lack of female role models in this field.”, “Female Orthopedic Surgeons are less likely to be employed”, “Women are less likely to attain leadership positions in the Orthopedic field.”, “Orthopedics is considered socially to be "more suited for men"”, and “Patients are less likely to visit female Orthopedists.”
Table 4.
Comparison of the perceptions of Orthopedics as a specialty in male and female medical students and assessing for statistical significance
| Question | Gender | Agree (%) | Neutral (%) | Disagree | Total | p value |
|---|---|---|---|---|---|---|
| Orthopedics is a very competitive speciality | Female | 118 (56.73) | 80 (38.46) | 10 (4.81) | 208 | 0.123 |
| Male | 124 (61.08) | 62 (30.54) | 17 (8.37) | 203 | ||
| Orthopedic surgeons are the "jocks of the medical field" | Female | 50 (24.04) | 110 (52.88) | 48 (23.08) | 208 | 0.214 |
| Male | 41 (20.2) | 100 (49.26) | 62 (30.54) | 203 | ||
| Orthopedics is an unsatisfying speciality | Female | 23 (11.06) | 50 (24.04) | 135 (64.9) | 208 | 0.716 |
| Male | 23 (11.33) | 42 (20.69) | 138 (67.98) | 203 | ||
| Orthopedics requires high physical strength | Female | 142 (68.27) | 45 (21.63) | 21 (10.1) | 208 | 0.05 |
| Male | 115 (56.65) | 60 (29.56) | 28 (13.79) | 203 | ||
| Orthopedic surgeries are long and require high stamina | Female | 127 (61.06) | 65 (31.25) | 16 (7.69) | 208 | 0.559 |
| Male | 132 (65.02) | 60 (29.56) | 11 (5.42) | 203 | ||
| A very high IQ is required to specialise in Orthopedics | Female | 46 (22.12) | 83 (39.9) | 79 (37.98) | 208 | 0.04 |
| Male | 33 (16.26) | 106 (52.22) | 64 (31.53) | 203 | ||
| An interest in sports is required to enjoy Orthopedics | Female | 25 (12.02) | 53 (25.48) | 130 (62.5) | 208 | 0.002 |
| Male | 43 (21.18) | 67 (33.0) | 93 (45.81) | 203 | ||
| There is insufficient exposure to Orthopedics at an undergraduate level | Female | 146 (70.19) | 47 (22.6) | 15 (7.21) | 208 | 0.775 |
| Male | 137 (67.49) | 48 (23.65) | 18 (8.87) | 203 | ||
| There is a lack of female role models in this field | Female | 156 (75.0) | 47 (22.6) | 5 (2.4) | 208 | 0.014 |
| Male | 137 (67.49) | 48 (23.65) | 18 (8.87) | 203 | ||
| Orthopedics has a poor work-life balance | Female | 62 (29.81) | 93 (44.71) | 53 (25.48) | 208 | 0.141 |
| Male | 47 (23.15) | 110 (54.19) | 46 (22.66) | 203 | ||
| There is a lack of financial security in Orthopedics | Female | 16 (7.69) | 61 (29.33) | 131 (62.98) | 208 | 0.724 |
| Male | 12 (5.91) | 64 (31.53) | 127 (62.56) | 203 | ||
| There is a lack of autonomy in Orthopedics | Female | 24 (11.54) | 134 (64.42) | 50 (24.04) | 208 | 0.186 |
| Male | 23 (11.33) | 115 (56.65) | 65 (32.02) | 203 | ||
| There is a lack of companionship and cooperation in Orthopedics | Female | 36 (17.31) | 96 (46.15) | 76 (36.54) | 208 | 0.956 |
| Male | 33 (16.26) | 94 (46.31) | 76 (37.44) | 203 | ||
| Female Orthopedic Surgeons are less likely to be employed | Female | 101 (48.56) | 65 (31.25) | 42 (20.19) | 208 | 0.000 |
| Male | 55 (27.09) | 77 (37.93) | 71 (34.98) | 203 | ||
| Women are less likely to attain leadership positions in the Orthopedic field | Female | 110 (52.88) | 51 (24.52) | 47 (22.6) | 208 | 0.000 |
| Male | 60 (29.56) | 74 (36.45) | 69 (33.99) | 203 | ||
| Orthopedics is considered socially to be "more suited for men" | Female | 156 (75.0) | 31 9 (14.9) | 21 (10.1) | 208 | 0.000 |
| Male | 113 (55.67) | 57 (28.08) | 33 (16.26) | 203 | ||
| Patients are less likely to visit female Orthopedists | Female | 140 (67.31) | 39 (18.75) | 29 (13.94) | 208 | 0.000 |
| Male | 86 (42.36) | 67 (33.0) | 50 (24.63) | 203 |
The above data plays an important role in understanding the perception of orthopedics among undergraduate medical students, as well as understanding the hesitancy of female medical students to specialize in orthopedics.
Discussion
While the number of women in medical school, and other male dominated surgical fields apart from Orthopedics is gradually increasing [10, 11]; this increase is not reflected in Orthopedics, in which the number of women lag behind at only 4% in the US [2] and 1% in India [3]. This study aimed at assessing the pre-formed notions and perceptions of medical students in all years of medical school and the possible reasons they might not consider Orthopedics as a surgical specialty. To our knowledge this study is the first of its kind done on Undergraduate medical students in India, although similar studies [8, 9] have been conducted on medical students abroad.
This study is limited in several ways. Firstly, we only assessed the opinions of medical students of one college in India. The opinions of these medical students may not accurately represent the opinions and ideas of all medical students across India. While the respondents in our study varied in their age, year of training, current level of clinical exposure to Orthopedics, background, and pre-formed notions about Orthopedics, it is difficult to ascertain how accurately the opinions of the general medical student population of India was represented in our study.
Secondly, although the survey was sent to 800 medical students including 244 females and 556 males, we only obtained a response from 411 (51.4%) of medical students of which 208 were females and 203 were males. This may lead to a response bias i.e. the opinions of the medical students who did not respond may differ from those who did. Further, there is a gender bias in those who chose to respond to the questionnaire as 85% of females to whom the questionnaire was sent chose to respond while only 37% of males responded.
Thirdly, almost 40% of respondents are first and second year students who have not been theoretically or practically exposed to the subject of Orthopedics.
Students of all classes participated in this study, with the highest number of students from the final year (24.6%) and the lowest number of participants from the Interns (only 13.4%), this may be due to their high workload and less free time.
Gender was found to be significantly associated with willingness to become an Orthopedic surgeon (p value of 0.00006286), with males being 2.3 times more likely to take Orthopedics. This is corroborated by the findings of a similar study [9] conducted by Baldwin et al. in which men were found to have a higher baseline interest in Orthopedics.
We considered first years and second years to have had no exposure to Orthopedics, and third years, final year students and interns to have had either theoretical or practical exposure to the subject. Those who had theoretical or practical exposure to the subject were found to be 1.4 times as likely to choose Orthopedics as compared to those who did not have either theoretical or practical exposure. The above is in line with the results of a similar study [12] conducted by O’Connor on medical students. However, while overall, “insufficient exposure to Orthopedics” was regarded as one of the top causes for lack of interest in the field, this was not found to be supported by the data in our survey as theoretical or practical exposure to the subject was not significantly associated with the urge to choose Orthopedics as a specialty (p value 0.099).
In our study, only 26% of female students were willing to become Orthopedic surgeons, which is slightly more than the 24% of female students who expressed interest in Orthopedics in the study conducted by Bucknall [8] in the UK.
Interestingly, in the General Perception of orthopedics category, less women than men think that Orthopedics is a competitive specialty i.e. 61% men and 57% women. 11.3% men and 11.1% women found it to be an unsatisfying specialty. This shows that the perception of orthopedics as unsatisfying or competitive does not result in the paucity of female surgeons in this field.
Surprisingly, few males and females perceived Orthopedics to have a “jock and fraternity culture” (24% females and 20% males). However, in contrast, a survey done at Harvard showed 54.4% of medical students thought that minimizing the “jock and fraternity culture” of orthopedics would encourage female participation in the subject (C. Day, MD, unpublished survey, Harvard University, 2012). This may be due to regional and social differences in opinions about orthopedists.
More women than men (68% of women and 57% of men) thought that Orthopedic surgery required high physical strength to perform, and this was found to be statistically significant (p value 0.05). This is a very common conception about Orthopedics. A study conducted by Rohde et al. [7] on female orthopedic surgeons showed a similar result, where 70% of female orthopedic surgeons thought that the perception of a high requirement of physical strength in orthopedics hindered women from opting for orthopedics. A majority of both men and women also agreed that Orthopedics requires high physical stamina. In contrast to Rohde’s study, the above did not qualify among the top 3 drawbacks of choosing Orthopedics among female medical students.
While only 12% of female medical students thought that an interest in Athletics was required to enjoy Orthopedics, this was found to be statistically significant when compared to male medical students (p value 0.002). A study performed by Miller and LaPorte [11] showed that 46% of female orthopedic surgeons listed Athletics as a main influence in their decision to pursue Orthopedics. This shows that those who do pursue Orthopedics are more likely to have a higher interest in sports. This may be because those with Athletic interests are more likely to be exposed to Orthopedics before medical college and personal and independent exposure to Orthopedics were both found to be significantly associated with the desire to pursue Orthopedics [9].
A high number of both males and females (68% of males and 70% of females) agreed that there was insufficient exposure to Orthopedics at an undergraduate level. Personal, independent and school exposures to Orthopedics were all found to be significantly associated with interest in Orthopedics among women in studies by Baldwin et al. [9] and O’Connor [12]..
A significant number of female medical students compared to male students (p value 0.014) agreed that there was a lack of female role models in this field. This is further proven in a survey of 76 orthopedic departments conducted by Nguyen et al. [13] in 2007 which found that 20% had no female faculty, 20% had no female residents, all of the programs were chaired by men, and nearly all (97%) had a male residency program director. Male domination in this field was also listed as a primary factor causing disinterest in Orthopedics among women in similar studies by Bucknall [8] and by Baldwin et al. [9]. It has been found that the minimum number of females in a field should be 30% to avoid appearing as a “male dominated field” [14]. The low number of female orthopedists perpetuates the reputation of Orthopedics being a “boys club”. The lack of women in this field also results in less number of female mentors being available- the importance of proper mentorship has been emphasized in a study by Flint et al. [15] who found that 96% of orthopedic residents considered mentorship either critical or beneficial to their training. The lack of visibility of female orthopedists deters other women from becoming Orthopedists-unless women see other women opting for Orthopedics, they are less likely to choose it [16]. A study[17] in Australia found that 72% of female medical students were discouraged from pursuing a surgical specialty due to the lack of female role models in surgery.
Positive responses for the Work and Lifestyle category were fewer than the other categories.
Only 30% of female medical students considered orthopedics to have a poor work-life balance as compared to 23% of men. This is in stark contrast to a finding by Rohde et al. [7] in the USA, in which 78% of female orthopedists thought that the fear of the poor work-balance would deter female medical students from opting for orthopedics. In a study done on Indian female orthopedists by Madhuri and Khan [18], only 40% of women perceived a difficulty in maintaining work-life balance and this was thus not considered a major issue. The difference may be due to a regional difference in the number of working hours among orthopedists. Additionally, only 8% of women feared a lack of financial security in orthopedics, 12% of female medical students thought Orthopedics had a lack of autonomy, and 17% of female medical students were apprehensive of a lack of companionship and cooperation among Orthopedists. The above suggests that work and lifestyle considerations are not important factors deterring women from applying for orthopedics in contrast to other studies [17].
In contrast to the Work and Lifestyle factors, opinions in men and women about questions in the “Opportunities for women in Orthopedics” category were found to be significantly different as can be seen in Table 4, with women perceiving much lower opportunities for women in the field. This highlights how important career opportunities are in convincing women to opt for Orthopedics.
A large number of female medical students thought that women were less likely to attain leadership positions in orthopedics (53%), orthopedics is considered socially to be “more suitable for men” (75%) and patients are less likely to be willing to visit female orthopedists (67%). The perception that women are less likely to attain leadership positions in orthopedics is confirmed by a study done on Indian female orthopedists, in which of 120 respondents, only 5 (4%) held leadership positions. The perception that orthopedics is considered socially more suitable for men may also have resulted in the difficulty faced by 25% of female orthopedists in getting into a training program [18].
The aforementioned perception, and also the idea that patients are less likely to visit female orthopedists may be due to the small number of female orthopedists being seen as “token members” [19] i.e. as representatives of the entire group instead of as individuals. This is a direct consequence of the low number of female orthopedic surgeons. When a token member underperforms, observers are more likely to generalize the claim that women orthopedists underperform as compared to males, which perpetuates the idea that orthopedics is a specialty for males and patients will be unwilling to be treated by a female. This further causes less number of women to opt for orthopedics and turns into a vicious cycle.
In conclusion, our data suggests that gender is significantly associated with willingness to become an Orthopedic surgeon (adjusted p value of 0.00016) with men being 2.27 times more likely to pursue the subject. The results also show main drawbacks of orthopedics to female medical students are- orthopedics is considered to be “socially more suited for men”, lack of female role models in this field, and insufficient exposure to orthopedics at an undergraduate level. The above factors inhibit women from choosing Orthopedics as a specialty, leading to a paucity of female orthopedic surgeons and a large gender gap in this field.
Increasing the number of female orthopedic surgeons is an important step in improving the access of care as studies have shown that female patients prefer female doctors [5]. A multi-pronged approach is required to achieve the above and changes are required to be made at the departmental, institutional and national organization levels.
Steps taken outside of India to increase the representation of women in Orthopedics include pipeline programs that have been implemented in America and other countries, including but not limited to the Perry Initiative Medical student outreach program, the American Academy of Orthopaedic Surgeons (AAOS) Inaugural Medical Student Program (2016), the B.O.N.E.S. (Bringing Orthopaedics to New England Students of Medicine) Initiative, and formal mentorship programs such as Nth dimensions and the NYU Summer Externship program. Pipeline programs are those programs which are specifically designed to provide career and educational opportunities to underrepresented minorities. Studies [20, 21] have proven these programs to be effective, even increasing the match rate into Orthopedics to twice their initial value.
The AAOS through its Diversity Advisory Board has started awareness programs in America to clear any preconceptions related to pursuing a career in Orthopedics and to encourage minorities to become Orthopedic surgeons.
While the steps taken outside of India to increase representation are commendable, Orthopedists across India are also taking steps to reduce the gender gap.
Female Orthopedic surgeons across India were invited to form the WOICE- Women’s Orthopedic Surgeons of India Collective, a part of the Indian Orthopedic Association. 221 female Orthopedic surgeons from India joined WOICE [18] at its initiation and 369 members as of December 2022, which was then instrumental in providing a platform to raise awareness about the challenges faced by women in Orthopedics in India. They also encourage other women to become Orthopedic surgeons by acknowledging prominent female Orthopedic surgeons in India such as the late Dr PK Mullaferoze and providing mentorship and encouragement to aspiring female orthopedic surgeons. Other similar organisations and mentorship programs should be implemented and encouraged in India to rectify the dearth of female Orthopedic surgeons.
Apart from the above, 33.33% seat reservation for Female Post Graduate candidates was initiated in 2022 in the states of Andhra Pradesh [22] and Telangana [23] in a plea to increase the number of female doctors across all medical specialties. This is a great step forward in bridging the gender gap. Similarly, other states across India should follow in the footsteps of Andhra Pradesh and Telangana and reserve a similar number of seats for women doctors.
Further steps that associations such as the Indian Orthopedic Association can take to increase the number of female Orthopedists include public education programs to reduce the stigma against female orthopedic surgeons in the general population. These programs should aim to counter popular prejudices people may have against female orthopedists such as the thought that female orthopedic surgeons are not strong enough or do not have the required stamina for the specialty. This would help in countering one of the main reasons female medical students listed for not opting for Orthopedics in this study- Orthopedics is considered “Socially more suitable for men.”
Other possible steps include increasing the visibility and support for existing female orthopedists which may be done through posters, programs and social media, much in the way WOICE did for the late Dr PK Mullaferoze. This would counter the second main issue female medical students listed- “ There is a Lack of Female Role Models in this field.”
A step that could be taken to rectify the “insufficient exposure to orthopedics at an undergraduate level” would be the restructuring of the MBBS syllabus by National and State medical councils to introduce theoretical and clinical exposure to orthopedics at an earlier level such as the first or second year of medical education.
While reservation has been introduced statewise for female doctors in some states, similar reservations should be made in Leadership positions within departments or associations. Increasing exposure to existing leadership opportunities may also go a long way in increasing diversity in the Orthopedic workforce.
Other ways of increasing opportunities for women within the sphere of Orthopedics include educational grants, nominations to committees, and fellowships for women [24]. All of the above will make female medical students more aware of opportunities in Orthopedics and encourage them to pursue the subject.
Further efforts should be made to engage with aligned partners and take part in inclusivity programs which are proven to have better outcomes.
In addition to the above suggestions, we would also recommend a multicentric study to address the drawbacks of this study and properly represent the wide variation of social and cultural norms across India which may influence the perception of Orthopedics among medical students. A higher number of third years, final years and interns should be sampled to further increase the relevance of the results as first year and second year students have not been exposed to the subject of Orthopedics.
Appendix A
A Questionnaire on "Where are the Women in Orthopedic Surgery?- A Study In Medical Students of a Tertiary Care Hospital in India Assessing The Possible Causes for the Low Number of Female Orthopedic Surgeons”.
This study aims to assess the possible causes of low number of female Orthopedic surgeons in India and the perception of Orthopedics as a specialty by Undergraduate medical students.
You have been chosen as you are an Undergraduate medical student and your participation is not compulsory. If you choose to participate, you will have to fill out a questionnaire containing questions about your opinions on Orthopedics.
Your participation will contribute to research which may promote gender equality in the surgical field.
There are no disadvantages in taking part in this study. All your responses will be kept completely confidential.
All collected results will be further evaluated and analyzed.
We thank you for going through this consent form and highly appreciate your participation in this study.
*Required.
Do you give your consent to participate in this study? *- Yes No.
Demographic Data: This section collects demographic data about undergraduate medical students.
Gender *—Male FemaleOther.
Age in completed Years: (answer in numbers) *-
Current Year of Study: *—First Year Second Year Third Year Final Year Intern.
Are you thinking of taking Orthopedics as your specialty? *—Yes No.
Perception Of Orthopedics: This section assesses the Perception of Orthopedics as a specialty among undergraduate medical students.
General Perception: *
Orthopedics is a very competitive speciality. -Agree Neutral Disagree.
Orthopedic surgeons are the "jocks of the medical field". -Agree Neutral Disagree.
Orthopedics is an unsatisfying speciality -Agree Neutral Disagree.
Personal Attributes: *
Orthopedics requires high physical strength. -Agree Neutral Disagree.
Orthopedic surgeries are long and require high stamina. -Agree Neutral Disagree.
A very high IQ is required to specialise in Orthopedics. -Agree Neutral Disagree.
An interest in sports is required to enjoy Orthopedics. -Agree Neutral Disagree.
Experience/ Exposure: *
There is insufficient exposure to Orthopedics at an undergraduate level. -Agree Neutral Disagree.
There is a lack of female role models in this field. -Agree Neutral Disagree.
Work/Lifestyle Considerations: *
Orthopedics has a poor work-life balance.—Agree Neutral Disagree.
There is a lack of financial security in Orthopedics. -Agree Neutral Disagree.
There is a lack of autonomy in Orthopedics. -Agree Neutral Disagree.
There is a lack of companionship and cooperation in Orthopedics. -Agree Neutral Disagree.
Opportunities for Women in Orthopedics: *
Female Orthopedic Surgeons are less likely to be employed. -Agree Neutral Disagree.
Women are less likely to attain leadership positions in the Orthopedic field. -Agree Neutral Disagree.
Orthopedics is considered socially to be "more suited for men". -Agree Neutral Disagree.
Patients are less likely to visit female Orthopedists. -Agree Neutral Disagree.
Do you think that there are any other causes for the low prevalence of female orthopedic surgeons?
Funding
We declare that no funding, direct or indirect for our study was received.
Compliance with Ethical Standards
Conflict of Interest
There is no potential, perceived, or real competing and/or conflicts of interest among authors regarding the article.
Ethical Approval
All the co-authors have seen and approved the final version of the manuscript and it is not currently under active consideration for publication elsewhere, has not been accepted for publication, nor has it been published/reported earlier in full or in part. All the authors have been personally and actively involved in substantial work leading to the report, and will hold themselves jointly and individually responsible for its content.
Footnotes
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