Page 9 - Read Online

Page 123 Mari et al. Art Int Surg 2022;2:122-31 https://dx.doi.org/10.20517/ais.2022.12

INTRODUCTION
Over the last decades, female enrollment in medical schools has steadily increased. However, this growth
did not lead to a proportional rise in females studying surgical specialties, which seems unable to attract and
retain many young female doctors . Manifest and occult barriers still prevent young women from
[1]
[1-5]
enrolment, promotion, training opportunities, and career progression in surgical departments .

Several factors are responsible for the limitations in recruitment and advancement of young female doctors
in surgical specialties, such as social and cultural barriers, gender discrimination and harassment, surgical
lifestyle, and the lack of mentors and same-gender role models . The main perceived obstacles in achieving
[6]
a satisfying surgical career seem to be societal stereotypes, gender-biased mentality, and the lack of an
adequate work-life balance .
[7,8]

Despite discrimination and obstacles, no significant differences were shown between males and females in
learning surgical skills, among neither medical students nor surgical trainees [9-11] . However, gender disparity
was observed in self-confidence, self-evaluation, and perception of competence achieved: female surgical
trainees more often undervalue their abilities, especially their technical skills [10,12,13] . Independence, operative
exposure, and faculty opinions of female residents’ ability could be influenced by this attitude, constraining
opportunities for female surgeons in training.

To break through the glass ceiling in training for women in surgery, many solutions have been proposed.
An early education for students on gender discrimination, setting up formal and informal mechanisms for
identifying and preventing inappropriate behavior, promoting flexible career and work patterns, and
sponsoring female mentors and role models have been advocated as possible ways to reduce the gender gap
in surgery. Although these suggestions seem beneficial, they have not been enacted, and significant results
have not been achieved yet [14,15] .

Artificial intelligence surgery (AIS) could play a role in facing the gender gap in training and education of
surgical specialties. AIS studies how autonomously acting machines can understand, process, and perform
interventional actions. Machine learning (ML), deep learning (DP), computer vision (CV), and natural
language processing (NLP) are leading toward more autonomous actions in surgery, with diagnostic and
therapeutic potential . In this paper, we aim to analyze different applications of AIS for breaking down
[16]
gender disparity in the enrollment and training of women in surgery.

MAIN TYPES OF DISCRIMINATION IN SURGICAL EDUCATION AND TRAINING
Barriers to the choice of a surgical career
Many studies have analyzed the reasons preventing women from choosing surgical specialties. The main
deterrents for female doctors in pursuing a surgical career are the length of training, time to date or marry,
time available to spend with family, finding a good time during residency to have a child, taking maternity
leave during residency, and being too old after residency to have children .
[5]

Furthermore, the perception of gender-based discrimination, the presence of a glass ceiling, the opinion of
surgery as a male-dominated field, inadequate flexibility during training, and a lack of mentors or female
surgeons as role models were identified as other factors which dissuade women from choosing a surgical
path .
[17]