“Gender inequality really represents a spectrum of experiences,” said Amalia L. Cochran, MD, FACS, FCCM, in her opening remarks for Tuesday’s session, Gender Inequality. In her presentation, Reducing Gender Inequality in Training, she acknowledged that “ideally, we would be able to prevent things that are based in gender inequality. But what we can do, until the time comes when we have actually been able to wipe this out as an issue, is be activists by supporting our trainees.”


Dr. Cochran, vice-chair, education and professionalism, department of surgery, The Ohio State University, Columbus, believes that the biggest risk factors for people to experience harassment “are being female, being non-white, and then also being a resident of a surgical program,” with the most common discrimination occurring in general surgery. 


45 percent of women in surgery considered leaving or declining a position based on gender discrimination. To help combat this issue, “we need to create a reporting culture,” Dr. Cochran said. “It’s not enough to just have structures and systems in place where reporting can occur; you need to have a culture in which reporting is accepted and embraced.”


Julie A. Freischlag, MD, FACS, FRCSEd(Hon), chief executive officer and dean, Wake Forest Baptist Health, Winston-Salem, NC, has seen gender inequality throughout her surgical career but has taken steps to change that culture. “Since I’ve been dean at Wake Forest, 50 to 60 percent of every medical school class are women, and it’s been that way for about 15 years.” If you want to change the world, she said, you have to be in charge.


In her presentation, Reducing Gender Inequality in Faculty and Senior Positions, Dr. Freischlag encouraged women to have a hands-on approach to lead in their chosen field. “The jobs are big and they are stressful, but the success you can get by doing a good job in leading is amazing, and I want you to just say yes.” Developing faculty, attending leadership conferences and symposiums, mentoring and sponsoring others, adopting flexible policies, and changing the culture are some of the strategies suggested by Dr. Freischlag to eliminate gender inequality.


Being a “superb bystander” is another way to “help these macro-aggressions and micro-aggressions stop,” she said. Wake Forest developed an active bystander training guide that implores others to WAKE up; that is, Work with who you are, Ask questions, find Key people who could help, and Employ distraction techniques. “Get into those rooms, make a difference, and lead, and then things will change.”


“Minorities and women remain grossly underrepresented in academic medicine,” said Cherisse D. Berry, MD, FACS, assistant professor of surgery and associate trauma medical director, New York University School of Medicine, New York. She shared data in her presentation, Racial and Gender Disparities within Academic Surgery: A Call to Action, proving that the disparities between men and women in academic medicine “are striking” on all levels.


“Out of 337 chairs of departments of surgery, two are Asian women, two are Latino/Hispanic women, 12 are white women, and zero are African-American women. To date, there are no African-American female chairs of surgery,” Dr. Berry said. 


While discussing statistics on National Institutes of Health (NIH) grants, Dr. Berry stated, “From 1973 to 2017, there were roughly 16,000 NIH grants awarded. Women received about 1,600 of those grants.”


Although the evidence points to obvious gender disparities, Dr. Berry said there is hope and help from surgical organizations. “Several organizations and surgical societies, including the American College of Surgeons,” are beginning to prioritize the issue by creating task forces and publishing white papers with recommendations and guidelines.


At the beginning of his presentation, Mentoring Strategies to Reduce Gender Inequality, Thomas K. Varghese, Jr., MD, MS, FACS, said, “We have a problem. We know that. Let’s start doing something about it.” 


Mentorship was his focus in the session’s final speech. Mentorship should be proactive and not just crisis management, Dr. Varghese said, while also acknowledging that women have a harder time finding mentors than men. Women are told to go find a mentor “but are given no guidance on how to find a mentor,” he said. Many women say that when they are assigned a mentor, it feels like an “artificial relationship.”


Mentorship and menteeship are skills, said Dr. Varghese, associate professor of surgery, head of the section of general thoracic surgery, and program director, cardiothoracic surgery fellowship, University of Utah, Salt Lake City. “The more you do it, the better you get at it,” he said. 


Dr. Varghese offered six points every mentor should remember: choose a mentee carefully, establish a mentorship team, run a tight ship, head off rifts or resolve them, avoid committing mentorship malpractice, and prepare for the transition.


“Mentorship is critical for successful trainees and junior faculty,” he concluded. “These are skills to develop” and they offer “an opportunity for life-long learning.”