Gender associations with selection into Australian Orthopaedic Surgical Training: 2007–2019

Abstract

Background: Communities have better health outcomes when their clinicians reflect the diversity of the communities they serve. More than 50% of Australian medical school graduates are female, yet women represent less than 5% of Australian orthopaedic surgeons. Selection into orthopaedic surgical training in Australia is an annual, nation-wide process, based on curriculum vitae (CV), referee reports and performance in multiple mini-interviews (MMI). The influence of applicant gender on these selection scores was examined. Methods: The CV, referee reports and MMI scores used for selection for each year from 2007 to 2019 were analysed from the perspective of the applicant's gender. Results: Over the years of the study, male applicants had higher CV scores and referee report scores, which determined the gender proportions invited to interview. By contrast, the interview process and selection from interview did not demonstrate a gender association. Conclusion:We describe the impact of selection tools, utilized over the past 13 years, on the gender diversity of trainees commencing orthopaedic surgery training in Australia. Leaders in postgraduate training should examine commonly used selection procedures to identify and reduce the unconscious biases that may affect their performance and value.

Overcoming the Barriers to Diversity in Orthopaedic Surgery

“…A lack of applications from minority groups was identified in a survey as the third most reported barrier to increasing diversity in orthopaedic residency programs 16 . In another study, no association was found between gender and selection into Australian orthopaedic training programs among candidates who had been interviewed 40 . However, minority applicants, but not women, have been shown to have lower rates of admission into orthopaedic residency despite equivalent academic achievement 41 .…”

Gender associations with selection into Australian General Surgical Training: 2016–2022

“…Gender has been described to affect the tools utilized to select applicants into surgical training programs. [5][6][7][8] General surgery is the largest surgical training program in Australia. Therefore, addressing any bias and associated barriers for females accessing training is an important consideration to ensure there is a gender diverse workforce to provide surgical healthcare for Australia.…”

“…The bias against female reflects other studies, including that of the findings of a review into the selection processes for the Australian Orthopaedic Association. 8 Workplace factors may harbour unconscious bias towards a female's development of their CV. Importance of achievements such as rural clinical experience, higher educational degrees or research projects are deemed by points allocated by ABiGS.…”

“…Accordingly, this may limit the RR as a differentiating tool in determining an applicant's abilities and performance when compared to orthopaedic selection process where up to seven RR may be selected from any service consultant and three RR from other health professional staff with whom the applicant has worked over the last 2 years. 8…”

“…Bias against females was identified in the curriculum vitae (CV) and referee report (RR) components of the score. 8 As these two selection tools are utilized by many other Australian surgical training organizations, we postulate that there may also be gender bias in their selection processes.…”