Summary of the deterrents for women against applying for core surgical training
| Deterrents | ||
| Institutional factors | Quotes | |
| Career pathway | Taking years out of training. | ‘Experience out of surgical training seen as negative in surgery, like if you’ve had to take more than a year’s experience outside the foundation programme. Whereas, for example, in anaesthetics, that’s favoured so you get points for that.’ |
| Pay gap. | ‘Surgical specialties have the biggest pay gap.’ | |
| Expenses. | ‘Expenses caused an issue as it is “certainly very expensive doing surgical training and paying for the courses”.’ | |
| Work-life balance | Flexible working hours. | ‘Financial support and flexible working hours is not a thing.’ ‘I think it’s the way our training works, and you know it’s not all that flexible and I find out a bit frustrating.’ |
| Balancing responsibilities with dependents. | ‘Enough time, effort and family support to look after [children] or arrange childcare.’ | |
| Application process | Too many requirements. | ‘I didn’t have a full quality improvement project but had 5 published papers. But when I applied, that actually disadvantaged me, because I haven’t jumped through some of the heaps that I needed to.’ |
| Lack of support from the deanery. | ‘Deanery didn’t do anything to support my application process.’ | |
| Organisational culture | Quotes | |
| Discouragement | Discouragement from non-surgical specialties. | ‘A lot of the discouragement comes from people who don’t do surgery.’ |
| Discouragement from family. | ‘My whole family basically said don’t do medicine and then they said don’t do surgery.’ | |
| Stigma surrounding family life and women. | ‘You’re doing surgery that’s the end of you having any children.’ | |
| Discrimination | Male validation. | ‘They validate them more than you even though they’re more junior than you.’ |
| Proving yourself. | ‘You’ve got to spend a lot more time proving yourself and the bar will be set different.’ | |
| Sexism. | ‘Male colleagues making sort of sexist remarks.’ | |
| Prejudice. | ‘I do think slightly that women when they are at early stages of their surgical career, people still don’t fully assume you that you want to become a surgeon.’ | |
| Surgical type | Stereotypes of female surgeons. | ‘Someone who’s very… I would say… maybe male, maybe white middle class, maybe you know when you think about a surgeon… someone quite cold.’ |
| Stereotype of surgeons. | ‘Everyone thinks surgeons are going to be quite mean.’ | |
| Work environment | Lack of equal opportunities. | ‘People who are the loudest and the mouthiest will only get the opportunity and no one else.’ ‘Subtle undertone sometimes of men being given opportunities.’ |
| Male dominance. | ‘There will not only be more of them, but they will also have those positions of essentially running the other parts of the Department and having a greater say.’ | |
| Resentment over less than full-time workers. | ‘As soon as someone on the rota goes part-time, it makes life harder for everyone else… [so] I think instead of resenting the system… you end up resenting the person who’s part time.’ | |
| Sexual harassment by consultants. | ‘And the consultant who had scrubbed in turned round to me and said “well, only if you give me a kiss” and stuck his cheek out. So I think that’s probably the worst example I’ve had. Stuff like that is really common that women have experienced particularly in surgery.’ | |
| Social factors | Quotes | |
| Dependents | Having children means that training takes longer. | ‘I do know people who do have children and they’ve done less than full time training, but it does take a really long time.’ |
| Wanting to have children is a deterrent. | ‘If I did have children, I’d- I wouldn’t go down the surgical route.’ | |
| Geographical limitations due to dependents. | ‘If I had dependents that were committed to a specific geographical location, for whatever reason, because that’s where our support network is and so on that is then another.’ | |
| Family life | Impact of training on future relationships. | ‘This path would have some kind of impact on… future personal relationships, marriage relationships, and relationships that weren't even formed.’ |
| Wanting a family life is a deterrent. | ‘I’m not married and I'm single, but it’s something that is constantly there at the back of my mind.’ | |
| Compromise is necessary. | ‘Quite a lot of sacrifices to keep their family together.’ | |
| Personal factors | Quotes | |
| Exposure | Negative experiences in foundation training can be a deterrent. | ‘What you were exposed to as an F1 and F2 probably does really influence your decision-making process or bias.’ |
| Lack of early exposure to surgery. | ‘Surgery gets shoved under in the curriculum and you don’t get much exposure to it as a student.’ | |
| Finance | Financial burden of extra courses needed for applications. | ‘To pay for all of the exams and courses that you’re expected to go on…if you want to have a kind of competitive CV for getting into higher specialty training.’ |
| Financial problems. | ‘I think if I had all of those at the back of my mind, then I may consider taking a year or something.’ | |
| Resilience | Necessity to handle negative comments. | ‘Develop a thick skin after a while.’ |
| Wanting to pursue extra hobbies but afraid of stigma. | ‘Don’t want to be seen as being lazy or not interested… [but I] want to do a lot of singing and basically piano…and all of those things have largely slipped away.’ | |
| Personality affects the number of perceived barriers. | ‘Probably difference between like perceived barriers there and actual barriers.’ | |