Table 1

Summary of the deterrents for women against applying for core surgical training

Institutional factorsQuotes
Career pathwayTaking 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 balanceFlexible 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 processToo 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 cultureQuotes
DiscouragementDiscouragement 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.’
DiscriminationMale 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 typeStereotypes 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 environmentLack 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 factorsQuotes
DependentsHaving 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 lifeImpact 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 factorsQuotes
ExposureNegative 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.’
FinanceFinancial 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.’
ResilienceNecessity 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.’