Residency Selection Preferences and Orthopaedic Career Perceptions: A Notable Mismatch

Abstract

Background Despite near-equal enrollment of males and females in medical schools, orthopaedic surgery continues to have one of the lowest percentage of female orthopaedic residents. This suggests there may be factors that specifically influence females to select other specialties. Some of these possible reasons have been explored in other studies; however, in this study, we sought to identify latent or unobserved variables that may be influencing this difference by conducting an explanatory factor analysis of male and female residency preferences. Purposes/questions In this study, by surveying a cohort of medical students at a single institution, we asked, is there a difference between males and females (1) in their perception of orthopaedic surgery and (2) in their preferences for residency and practice? We further asked, if there are differences, (3) is there a correlation between perception and preferences for residency and practice? Methods A 46-question survey was sent to all current medical students (n = 628) at a major urban university with near-equal enrollment of males (55%, 345 of 628) and females (45%, 283 of 628) from September 2017 to November 2017. The survey consisted of two main parts: (1) desired attributes of a residency program and (2) perceptions of orthopaedic residency and practice. The design of the survey instruments closely followed The Checklist for Reporting Results of Internet E-Surveys (CHERRIES) checklist and went through several variations and pilot studies before release. In all, 33% (205 of 628) total medical students responded to the email survey, 55% (112 of 205) were male and 45% (93 of 205) were female. The proportion of male and female respondents matched the gender distribution of the total population surveyed, which at the time of the survey was 55% male and 45% female. The data analysis was performed using a Mann-Whitney U test and an explanatory factor analysis. The explanatory factor analysis was used to identify the correlation between survey variables among male and female students. An alpha less than 0.05 was considered significant for the Mann-Whitney U test and a factor greater than 0.5 was considered significant for the factor analysis. Results Both male and female students ranked “work-life balance” and “variety in specialty” among the top three most important preferences. Females ranked “range of practice options,” higher than males (72% females versus 60% males, r = 0.18; p = 0.009), and males ranked “previous exposure to the specialty” higher than females (65% females versus 71% males, r = 0.03; p = 0.70). Both male and female students had similar overall perceptions of orthopaedic surgery. Both males and females indicated that orthopedics is “male dominated,” has “competitive entrance requirements,” and requires “long residency work hours.” They differed in their perception of “requires physical strength” (60% females versus 38% males, r = 0.28; p < 0.0005), and by how much orthopaedics is “male dominated” (95% females versus 77% males, r = 0.26; p < 0.0005). The factor analysis recognized that, although male and female students do have some similar residency preferences, the influence or weighing of those preferences is different for male and female students. In a manner similar to a personality assessment, the factor analysis produced four latent factors that can help explain variation seen in responses and helped identify influential factors that were not directly tested by the survey. The first such latent factor for females consisted of “work-life balance,” “residency length,” "residency work hours,” and “family-friendly specialty.” Although the first latent factor for males consisted of “prestige,” “income potential,” “grade or step scores,” and “competitiveness of residency program.” The three subsequent latent factors also displayed variation in the make-up of the latent factors between males and female students. Conclusions This study of medical students at an urban medical school found that male and female students shared many preferences for residency specialties and held many of the same perceptions regarding orthopaedic surgery. The explanatory factor analysis indicated that male and female students weight preferences differently when selecting a specialty; this difference may account for the large differences in proportion between males and females in orthopaedic residency. Clinical Relevance Attracting talented residents and attending physicians is important for the success of any medical department. Although orthopaedics attracts some of the most talented students, these students are predominantly male. By identifying the multifactorial areas that may be inadvertently discouraging females from applying, orthopaedic residency programs may be able to better address those issues and attract the best talent of both genders.

Current Perceptions of Diversity Among Head Team Physicians and Head Athletic Trainers: Results Across US Professional Sports Leagues

“…Studies detailing associations among orthopaedic institutions’ faculty diversity, resident diversity, and the diversity of the applicant pool of medical students suggest the perception of diversity is an important factor. 27 , 28 , 36 , 48 Additional investigation of these topics is warranted, for which our initial study may serve as a benchmark and impetus for increased participation from professional leagues, allowing for more robust data collection in future iterations.…”

Current challenges for women in orthopaedics

“…In 2018, a UK study assessing the effects of the ‘Hidden Curriculum’ across 13 medical schools discovered that 66% of students had heard negative comments about surgery and 27% altered their career plans as a result. 19 Furthermore, Whitaker et al 20 reported 95% of female medical students perceived orthopaedics to be a ‘male dominated speciality’, and 60% felt orthopaedics ‘requires physical strength’. Although orthopaedics is more physically demanding than specialities such as ophthalmology, modern-day techniques and technology have made it easier for women to operate.…”

Women and men in orthopaedics

“…Although the first latent factor for males consisted of "prestige," "income potential," "grade or step scores," and "competitiveness of residency program." By identifying the multifactorial areas that may be inadvertently discouraging females from applying, orthopaedic residency programs may be able to better address those issues and attract the best talent of both genders [42]. For example, it is important to teach female medical students that orthopedic surgery has greatly progressed from the brute force discipline of the past, with new techniques and equipment decreasing the strength requirement [43].…”

“…Although females pursue orthopaedic residency less frequently than males, performance during residency should not bias their future selection. Whitaker et al [ 42 ] reported, by surveying a cohort of medical students at a single institution, that both male and female students ranked “work-life balance” and “variety in specialty” among the top three most important preferences. Females ranked “range of practice options,” higher than males, and males ranked “previous exposure to the specialty” higher than females.…”

“…Both males and females indicated that orthopedics is “male-dominated,” has “competitive entrance requirements,” and requires “long residency work hours.” They differed in their perception of “requires physical strength” (60% females vs. 38% males), and by how much orthopaedics is “male-dominated” (95% females vs. 77% males). The first latent explanatory factor for females consisted of “work-life balance,” “residency length,” “residency work hours,” and “family-friendly specialty.” Although the first latent factor for males consisted of “prestige,” “income potential,” “grade or step scores,” and “competitiveness of residency program.” By identifying the multifactorial areas that may be inadvertently discouraging females from applying, orthopaedic residency programs may be able to better address those issues and attract the best talent of both genders [ 42 ]. For example, it is important to teach female medical students that orthopedic surgery has greatly progressed from the brute force discipline of the past, with new techniques and equipment decreasing the strength requirement [ 43 ].…”