Inappropriate Questions Asked of Female Orthopaedic Surgery Applicants From 1971 to 2015: A Cross-sectional Study

Abstract

Introduction:The Civil Rights Act prohibits employers from making employment decisions based on sex, race, color, religion, or national origin. Questions regarding these topics during a residency interview are therefore prohibited. Methods: A questionnaire was sent to all female orthopaedic surgeons who had an e-mail address in the American Academy of Orthopaedic Surgeons directory. Participants were asked to describe what, if any, inappropriate questions they were asked during interviews.Results: Four hundred eighty-eight of 997 invited female orthopaedic surgeons completed the questionnaire (48.9%). Their residency interviews took place from 1971 to 2015. Overall, 61.7% of participants were asked an inappropriate question during an interview. This proportion neither increased nor decreased from 1971 to 2015 (P = 0.315). The most common themes of questions included "raising children during residency" (37.9%), "marital status" (32.4%), and "pregnancy during residency" (29.7%). Of those who were asked an inappropriate question, only 1.4% reported the inappropriate question to authorities. Discussion: The present study suggests that over half of female applicants have been asked inappropriate questions at orthopaedic surgery residency interviews, and that there has been no improvement in that percentage over nearly five decades. It is the responsibility those interviewing to be aware of this issue and to be in compliance with national guidelines. Level of Evidence: Level IVT he 2016 census of the American Academy of Orthopaedic Surgeons (AAOS) reveals that only 5.3% of American orthopaedic surgeons are female. 1 Moreover, even though women make up 47% of medical students, only 14% of orthopaedic surgery residents are female. 2 Orthopaedic surgery has a lower proportion of female residents than any other medical or surgical specialty, including general surgery, neurosurgery, urology, and plastic surgery. 3 Title VII of the Civil Rights Act of 1964 prohibits employers from making employment decisions on the basis of sex, race, color, religion, or national origin. 4 The Pregnancy Discrimination Act prohibits discrimination on the basis of pregnancy, childbirth, or

Early Barriers to Career Progression of Women in Surgery and Solutions to Improve Them

“…In total, 13 papers50–62 concentrated on gender discrimination during the process of residency application, including recommendation letters51–55 and interview,56–60 and fellowship applications 61,62. In standardized letters of recommendation most of these differences seem to disappear 52.…”

“…The main reasons for not reporting harassment have been found to be "fear of negative impact on my career" (43%), "fear of retribution" (32%) and "fear of being dismissed and inaction towards perpetrator" (31%), 49 "feeling that nothing would come of it if reported" (44%), "not being aware about institutional mechanisms to report harassment" (34%). 47 In total, 13 papers 50-62 concentrated on gender discrimination during the process of residency application, including recommendation letters [51][52][53][54][55] and interview, [56][57][58][59][60] and fellowship applications. 61,62 In standardized letters of recommendation most of these differences seem to disappear.…”

A 15-Year Report on the Uneven Distribution of Women in Orthopaedic Surgery Residency Training Programs in the United States

“…Samora et al 19 found that 81% of female respondents of an AAOS survey had experienced discrimination, bullying, or harassment. Similarly, in a Ruth Jackson Orthopaedic Society survey, 68% of women reported having experienced sexual harassment during their orthopaedic training, and 61.7% reported being asked an inappropriate question during residency interviews, including issues about child-bearing and marital status 20 , 21 . In a survey of women in orthopaedics, 74% had experienced microaggressions, which are defined as verbal, nonverbal, or environmental slights that are either intentional or unintentional conveying hostile, derogatory, or otherwise negative messages 22 .…”

Bias Mitigation in Cardiothoracic Recruitment

“…In a study of women orthopedic surgeons, 61.7% were asked inappropriate questions about pregnancy and child-rearing during residency interviews. 5 This alarming percentage did not vary from 1971 to 2015. Furthermore, unstructured interviews have low interrater reliability and poor prediction of on-the-job performance.…”

“…Nevertheless, discrimination in hiring has not changed, perhaps because applicants rarely report discriminatory or inappropriate hiring practices. 5 Although antidiscrimination laws theoretically protect applicants, fair hiring practices are usually the result of employers' commitment to uphold these laws. Cardiothoracic programs must critically review recruitment practices to ensure compliance with antidiscrimination laws and promotion of diversity.…”