Table 3.

Summary of the proposed implementations for women applying for core surgical training

Implementations
Institutional factors		Quotes
Early exposure	Increased hands-on exposure in undergraduate level.	‘Increased exposure to surgical specialities, I think it’s got to be fairly hands-on exposure.’
	Increased hands-on exposure in foundation level.	‘Think that’s probably why there’s a reasonable number of people who pull out of training during- because you just don’t really ever get a true idea of what life as a surgical trainee is going to be like. But then I would think that increased exposure, because that’s what I would enjoy.’
Representation	Increased female representation.	‘There needs to be more gender representation. There needs to be more diversity.’
	Having more females in positions of leadership.	‘I think more female leadership, more so. ****, she’s the head of the GMC at the moment. She is a female surgeon which is great and I think that’s important as well.’
Support	Offering maternal support to women.	‘Identifying the need for it and then addressing the actual day to day practical factors, like less than full-time work and work challenges you might have. Like mothers for financial support, support with coming back to work and flexible training and working hours.’
	Having a standardised checklist of application requirements in one accessible place.	‘Because it changes every year, it’s changed for us this year compared to last year and there’s a lot of new things but just having that and then the option to sit down with someone to go through your portfolio if you can, that’s probably the main thing.’
	Application support from senior medical professionals (professional support).	‘Consultants taking an interest in you, and saying that they'll look through your portfolio and give you interview practise.’
Training process	Availability of run-through programmes.	‘Run-through training programmes are great for that. So, my friend is married and has two kids and she’s run-through training ENT.’
	Alternative pathways to training.	‘It would be much easier to sort of carve your own training without going through a training programme and I think for me that would be- yeah that’s a useful change.’
	Workshops to educate applicants.	‘I think it would be useful to have some like workshops and understand the patient process and what’s required of you and what they are looking for and expecting.’
Organisational culture		Quotes
Cultural shift	Help with conversations about comments in the workplace.	‘Frank conversation with them when I said as much as I appreciate where you’re trying to see my best interest. I personally don’t have those challenges, and if it comes to that point where, um, you know, say I do have children and I do. I need time off, the Deanery does support that and there are some kickass women with three children working less than full time and doing their thing and they've managed it.’
	Surgical teams need to accommodate females.	‘Just making the culture more accepting of having more female trainees.’
	Reduce prejudices against women.	‘Is possible and people just being generally supportive of “oh you want to be surgeon, great” rather than “oh you want to be a surgeon but you’re a woman”.’
Destigmatisation	Active engagement in undergraduate level,	‘I think just the engagement is really important, just show that you actually care and you know that this student exists somewhere in the theatres. You know like, just go “can you help me hold it” - like get them involved.’
	Breaking stigma of the surgical type of woman.	‘Maybe reducing I would say but it’s kind of again the notion, thing that women in surgery are real hard and cold and you know not very nice which is completely untrue.’
	Normalising less than full-time training in the workplace.	‘I still I find that quite daunting concept and I know that’s quite far away for me at the moment, but trying to get that understanding in the Department without being feeling like you are doing less because you are not there as much as some others, and to normalize that behaviour.’
	Destigmatising less than full-time training and its impact on life out of medicine.	‘And just this kind of it will take away so much of the pressure to be a perfect surgical trainee or a perfect partner or a perfect parent. I think it will actually mean that you have a longer term.’
Social factors		Quotes
Mentorship schemes	Mentoring schemes should start in medical school.	‘There’s tonnes of buddy schemes out there at the moment, but I think maybe starting this from undergraduate level would be nice.’
	Female role models established early.	‘Setting role models early and making female medical students think that they can do it, and know that it’s a possibility at that stage.’
	A mentor should be close in training position to help with applications.	‘So you might want to know like someone directly above you, like a year or two, that can get you through the applications. I think that will really make a difference.’
Networking opportunities	Spaces to get involved with research projects.	‘Setting up networking meetings at hospitals and stuff where people could give projects, show what projects have got on offer and if they need any help and things.’
	Joint groups with peers to practise interviews.	‘I think having a local group will be useful, where you can do face-to-face practise. I think that that’s a huge goal within the interview checklist itself.’
Personal factors		Quotes
Self-development	Time should be scheduled in the rota to be able to increase theatre time and grow professionally.	‘My job as an F1/F2 has been purely service provision and I really do feel, apart from if I came in on day-offs, I had no opportunity to go to theatre or go to clinic or do anything that like a specialty trainee might do. I do think that into the rota, it should have been scheduled for you to sometimes go to the theatre.’
	Time for self-development and career development.	‘F1 is really critical, because by the time you get to F2 and your first placement like literally the end of your first placement. I think having some of those afternoons, or even like a couple of hours, where you can just go and assist in a case or you can go to clinics, is so important for people’s choices. And those career conversations that go on very early on are really important, so I think if you were going to target anything to make a successful intervention, I’d really try and push up the F1 stage.’