S. P. Myers1, K. J. Nicholson1, K. Hill1, E. B. Littleton2, G. Hamad1, M. Rosengart1 1University Of Pittsburgh Medical Center,General Surgery,Pittsburgh, PA, USA 2University Of Pittsburgh,School Of Medicine,Pittsburgh, PA, USA
Introduction: Few studies focus on how gender affects the formation of professional identity during residency. Professional identity is integral to academic achievement and represents an essential component of the more comprehensive construct of self-concept. For surgeons, competence requires non-technical behaviors that support surgical learning and the development of professional identity. As residency is a formative period during which these intangible skills are acquired, we hypothesize that experiences during training diverge among genders and may be associated with differences in self-concept and professional identity.
Methods: A qualitative mixed-methods study of general surgery residents at the University of Pittsburgh Medical Center was performed. General Surgery residents participated in two survey instruments, a questionnaire and interview, that interrogated domains of self-concept and professional identity. Transcribed interviews were coded for recurring content using inductive methods. Coded data were evaluated for emerging themes. Data and interrater reliability were analyzed using Fisher’s exact tests and Cohen’s Kappa respectively. A p-value <0.05 was considered significant.
Results: Study participants included forty-two (87.5%) general surgery residents (24 males, 18 females), and the kappa values for coded data ranged from (0.63-0.83). Fewer female residents self-identified as a ‘surgeon’ (11.1% vs. 37.5%, p<0.001). All subjects reported that patients more frequently dismissed female residents’ professional role (p<0.001), that support staff hostility was more commonly directed at women trainees (p=0.015), and that attendings preferred working with male residents (p=0.001). Significantly more females recounted episodes of another physician disregarding their professional title (p<0.001), being the target of unprofessional sexual conduct (p<0.001), and hostile behaviors from attendings (p>0.001). All residents reported that women but not men were negatively stereotyped (p<0.001): cast as lacking confidence or authority, being physically or emotionally weak, having low professional or societal worth and being overly-aggressive. Significantly more female residents reported experiencing feelings of lack of mentorship, discomfort, feeling pressured to accept or participate in unprofessional behaviors, having difficulty completing tasks and having to adapt to overcome barriers (p<0.001). Nearly all the residents who communicated concern over barriers to career advancement were women.
Conclusion: Key events in training perpetuate preconceived impressions that women are inferior to their male counterparts. These can be disruptive to the development of self-concept and professional identity.