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Mari et al. Art Int Surg 2022;2:122-31 https://dx.doi.org/10.20517/ais.2022.12 Page 124

Analyzing the main barriers to selecting surgery as a specialty for medical students from 75 countries, the
Global Surgery Working Group identified difficult access to surgical training, long years of study, heavy
workload, and the high costs of training as the main issues for students from low and low-middle income
[18]
countries . Moreover, this study revealed that female students from low and low-middle income countries
were 40% less likely than their male colleagues to consider a surgical career when controlling for other
[18]
factors .
Factors that can increase female doctors’ interest in surgery have been the topics of different studies. Early
exposure to surgical specialties during medical school, mentorship, and role models were identified as the
factors which increase the likelihood that female doctors will pursue a surgical specialty [19-23] . Additional
ways to encourage women’s representation in surgical departments were flexible working patterns,
shortened training time, improved sense of belonging, and better work-life balance [24-27] .

Exposure to other women who have pursued a surgical career was considered one of the most inspirational
[28]
reasons to induce young women to follow a surgical career . Furthermore, suggestions and mentoring by
fellow surgical residents were shown to be even more effective than mentorship by a faculty member .
[19]
Mentorship and role models were recognized as one of the principal factors in supporting interest in
surgery [18,21,23,28] .

Surgical training
During surgical training, women had to face several obstacles, such as gender disparity, inequity during the
surgical residency application process and interview, imbalance in the bestowment of awards, sexual
harassment, and discrimination in pregnancy experience and parental leave.

In pursuing a surgical career, female doctors had to deal with gender discrimination during the procedure
of residency application, including recommendation letters [29-33] , interviews [34-38] , and fellowship
applications [39,40] . Furthermore, female applicants required superior letters of recommendation to be given
[30]
the same opportunity as male candidates . However, when standardized letters of recommendation were
requested, these disparities were not present .
[31]
During residency interviews, applicants frequently received questions about personal matters which were
unrelated to medical school performance. Female respondents more frequently experienced a potentially
illegal question compared to male applicants . Women were recurrently asked about marital status, family
[36]
[37]
planning, and maternity plans .
During surgical training, women experienced disparities in operative autonomy and evaluation, and
interesting differences were also observed in self-evaluation [11,41-48] . A significant difference between male and
female residents’ operative autonomy was observed during surgical training programs. Even though a
gender disparity in residents’ performance was not demonstrated, women tended to underestimate their
abilities compared to faculty assessment [46-48] .

Female residents were revealed to be more likely to experience several other kinds of discrimination during
their training, compared to their male colleagues. Female trainees more commonly experience stereotyping
and discrimination, such as being mistaken for non-physicians, being subject to different standards of
evaluation, and being victims of harassment [49-51] .