Introduction

While the medical field is becoming increasingly diversified, there are many surgical specialties within healthcare that are still heavily male-dominated. The American Medical Association released a report on specialties that had the highest unequal gender balances. Among the most male-dominated specialties, three surgery specialties were in the top six including orthopedic surgery (84.6%), neurological surgery (82.5%), and thoracic surgery (78.2%).1 Of the four careers with the most gender balance, none have any surgical implications.1

Several studies have sought to examine reasons for gender disparities among surgical fields. Assessing medical students, residents, and attending physicians alike, various projects sought to assess perceptions on deterrents to becoming a surgeon. Some participants expressed concerns with lifestyle, perceived personalities of surgeons, desire to have a family, and lack of role models.2–5

The purpose of this study was to assess medical students’ perceptions of surgeons before and after an event aimed at reducing stigmas surrounding surgical specialties through the utilization of pre- and post-surveys.

Materials & Methods

Virtual Event

The virtual event was developed by The UNC-CH School of Medicine Neurosurgery Interest Group and UNC-CH Association of Women Surgeons Chapter in conjunction with an attending Neurosurgeon at UNC, who recruited additional surgical attending physicians to serve as panelists. The event was marketed to women interested in surgery, but all were welcomed. The event titled “The Masked Surgeon” required surgical faculty, who served as panelist, to send three interesting facts, talents, or hobbies anonymously to student host prior to the event. At the event, medical students played a game where they matched panelists to their hidden talents and interesting facts. After the game, panelists were placed in individual breakout rooms and medical students were assigned by the host to a breakout room. Approximately, 3-4 students and one surgical faculty were in each individual breakout room to converse in a informal intimate space. The event was not recorded.

Surveys

This study received exemption approval from University of North Carolina Institutional Review Board. Even so, students were given a research form that outlined the purpose of the study, requirements to participate, data collection procedures, and potential risks and benefits of the study. It was emphasized to the students that participation in the study was completely voluntary and responses would not impact their evaluation as a medical student.

The pre-survey was administered electronically via email to all registered participants and a Qualtrics QI code was offered on Zoom as attendees logged on prior to the start of the event. The pre-survey collected age, gender, race, medical school year, and assessed initial knowledge and perceptions of surgical specialties. The questions surrounded perceptions were previously identified as determents to surgical careers in research, using Linkert scaling. A numerical scale was applied to scaling to quantify results for analysis.

The post-survey included another knowledge assessment, perception of surgeons, and feedback on the virtual activities’ effectiveness. The post-survey was administered via email to registered participants.

Both surveys responses were completed and collected via an anonymous online platform (Qualtrics). Names were not collected instead participants assigned themselves unique identifiers, that were not disclosed to researchers, to complete both surveys so pre and post responses could be compared. The pre-survey was closed following the start of the event and no additional responses were recorded. The post-survey was not available until event completion. Qualitative analysis using mean survey response with 95% confidence intervals was performed to compare responses of the pre- and post-survey, see Figure 1.

Figure 1
Figure 1.Mean student responses to survey questions pre and post-virtual event with 95% confidence intervals. Questions and answer choice descriptions are shown in table 1.

Results

Twenty-two students participated in the virtual event. Of the 22 students, 22 (100%) completed the pre-survey and 13 (59.1%) completed the post-survey. Only those who completed both surveys (n=13) data were included in the analysis. Twelve (92.3%) were female, 7 (53.8%) identified as Caucasian, 3 (23.1%) Black/African-American, 1 (0.7%) Asian. Of the 11 (84.6%) respondents who included their age, the average age was 25.4 years. Questions asked to assess surgical perceptions and knowledge are displayed in Table 1. Mean student responses of both surveys are shown in Figure 1. The largest change in mean score was in assessing the perception of interactions amongst surgeons (Q6).

Table 1.Pre and post-questionnaire.
Survey Questions Response choices (1-10)
Q1 How strongly are you considering surgery as a possible career choice? 1= not at all
10= very strongly
Q2 How diverse do you think surgical careers are? 1= no diversity
10= high diversity
Q3 In the era of healthcare reform, what do you perceive is the future of a surgical career? 1= bleak future
10= bright future
Q4 How emotionally draining do you perceive surgical fields to be for residents and attendings? 1= not draining
10= very draining
Q5 How difficult do you perceive surgical residency training to be? 1= not difficult
10= very difficult
Q6 In a surgical field, how do you perceive the personalities of attendings and colleagues and interactions between faculty to be? 1= unpleasant and unfriendly
10= very pleasant and collegial
Q7 What do you perceive a surgeon’s quality of life to be? 1= low quality
10= high quality
Q8 How achievable is it to be a surgeon and have a family? 1= not achievable
10= very achievable

Discussion

The virtual event at UNC involved engagement beyond a traditional meet and greet in the form of a game in a low-stress setting. The data showed that students’ perceptions of surgeons and pursuing surgical careers followed a more positive trend after the event. This suggests that social events can impact students’ perceptions of surgeons and surgical fields. Research has shown that these perceptions influence medical students’ decisions when choosing a medical career and can be deterrents for choosing some fields, such as surgery.2,4,5

While there are certain limitations in making conclusions about a small one-time event, it provides medical students opportunities to explore surgical fields and exposure to surgical mentors in a low-stress setting. Another advantage of this social event was the short-term, one-hour commitment. Diverse faculty who support diversity initiatives can be challenging to obtain due to limited bandwidth; however, the minimal commitment to events similar to this format may optimize engagement. Furthermore, while the pandemic may make exposure to surgical specialties complex, we provide another tool to reach students at multiple institutions.

This was just one event; however, studies have shown that early surgery exposure in preclinical years can increase student knowledge and form positive surgical perspectives.6 These exposures impact and change medical students’ perceptions and have the potential to foster mentorship and steps toward pursuing surgical specialties in their future careers.4,6 Through the feedback given, a theme was that being assigned to only one breakout room could be limiting to student participation and to offer more events like The Masked Surgeon throughout the year or in a structured virtual mentorship program. Future events will give students the ability to move about breakout rooms, as well as be intentionally scheduled by both interest groups. We offer this studied experience as an example of early virtual engagement opportunities value in expanding students’ knowledge and perception by exposing diverse them to surgical specialties and mentors.

Two limiting factors of this study are its sample size (n=13) and response rate (59.1%). Though the sample size is small, it is not uncommon in niche surgical interest groups. The low response rate primarily resulted from administering the second survey, which was sent via email the day after the event. For future evaluations, this suggests it may be helpful to send an email immediately after the event or provide the link after the event to increase accessibility for participants.

Conclusions

Virtual events alone will not fix surgical disparities; however, they could help provide students with opportunities to explore surgical interests. Virtual events offer convenient, efficient, and assessable platforms for educational initiatives. They allow collaboration among surgical faculty and students and increase the interface between surgeons and underrepresented groups in surgery. Most importantly, they offer a sustainable intervention for medical programs to develop culturally competent spaces to enhance diversity, equity, and inclusion in surgical spaces, independent of regional and institutional accessibility. In the future, more research needs to be conducted to explore interventions to address misconceptions that discourage students from pursuing surgical careers.

Acknowledgements

We would like to thank the students and surgical faculty at UNC Chapel Hill School of Medicine for participating in this event and allowing us to collect this survey data in hopes to evaluate and create spaces that foster the improvement of medical education and mentorship in medicine.

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.