Empowering Women in Global Surgery Through Mentorship

Mary Magdi, Education Lead

For over ten years, women have comprised approximately half of medical school students, yet they continue to be notably less represented in several specialties, particularly many surgical fields. Despite efforts, the advancement of women in the field of surgery has seen little improvement, with fewer than one-third of surgeons globally being female. Numerous factors shape the choices of junior female doctors in pursuing a surgical career. One such factor, reported across both high and low-income countries, is the absence of guidance and mentorship along their career path.

Formal mentorship initiatives surfaced in professional medical education environments during the 1990s, providing medical students with increased research chances, support in career choices, and improved personal and professional growth. So what precisely constitutes mentorship? What factors contribute to its effectiveness? How can mentorship help in various surgical settings to support the advancement of women?

The term "mentor" originates from Homer's Odyssey, where Mentor, a character, was entrusted by Odysseus to counsel and educate his son, Telemachus, during his absence for the Trojan War. Over time, "mentor" evolved to signify a guide and educator, and mentoring became synonymous with a teacher-student dynamic.  

Mentorship can have various definitions. For the purpose of this blog post we will define mentorship as a reciprocal connection and form of personal growth whereby one person dedicates their knowledge, effort, and time to aid another individual in their journey towards achieving their fullest potential and success.

Mentorship for women in surgery

Mentorship in surgery is important during different stages of one’s surgical career and provides different forms of support, including technical and non-technical skills. In the realm of global surgery, mentorship plays a pivotal role in shaping the careers and trajectories of aspiring surgeons, particularly women who often face unique challenges and barriers.

In many parts of the world, gender disparities persist within the surgical field, with women encountering obstacles ranging from cultural norms to systemic biases. The influence and absence of mentorship during training were examined across several articles, with discussions spanning high-income countries (HICs) and low-income countries (LICs). While mentors may be of any gender, female physicians have demonstrated higher satisfaction in reaching professional milestones when mentored by women, as opposed to those mentored by men.

Barriers faced

When it comes to securing mentorship, women encounter challenges regardless of the gender of potential mentors. In some instances, women have described difficulties in finding male mentors. Additionally, the search for senior female mentors presents another hurdle, as there is a scarcity of accessible and available senior women in the physician workforce willing to take on mentoring roles. These instances underscore a systemic barrier preventing women from accessing the benefits of mentorship, despite its well-documented advantages. 

Impact on women's careers

For women in surgery, mentorship plays a pivotal role in overcoming systemic barriers and achieving success. Tailored mentorship programs for women in surgery can effectively address gender-specific obstacles such as work-life balance, discrimination, and barriers to leadership roles. Women face a myriad of workplace challenges, including occupational segregation, wage disparities, biased evaluation and promotion processes, heightened risk of sexual harassment, and the impact of parental leave on career progression. Research also indicates that mentorship significantly influences career decisions, with female medical students more likely to pursue surgical specialties when exposed to female surgical role models. Moreover, mentorship addresses the gender disparity in leadership positions by providing women with access to advocacy, networking, and leadership opportunities.

Types of mentorship 

Various forms of mentorship present distinct dynamics and advantages. We will explore several of these approaches in the following discussion: 

1- Dyadic mentorship: This refers to a one-on-one mentoring relationship between a mentor and a mentee. This form of mentorship involves direct interaction and personalised guidance tailored to the specific needs and goals of the mentee. It emphasises a close and individualised approach to mentoring.

2- Peer mentorship: This involves colleagues providing coaching and guidance to one another, leveraging their shared experiences and expertise.

3- Reverse mentorship: Here, junior employees mentor leaders, offering fresh perspectives and insights from the viewpoint of a younger generation.

4-  Group mentorship: In this setup, a mentor supports and guides multiple mentees simultaneously, fostering a collaborative learning environment.

5- Flash mentoring: This entails brief sessions where employees interact with various mentors, facilitating quick knowledge exchange and networking opportunities, particularly beneficial for new hires seeking to connect with experienced leaders.

Stages of mentorship 

Mentoring differs from coaching, advising, teaching, tutoring, advocacy, sponsorship, and role-modelling by encompassing the creation of intricate, emotionally profound, and enduring relationships.

Mendler delineated 10 distinct phases of relationship progression within mentorship, a framework later elaborated by Pellegrini (See Table 1).      

Citation: Steelman K, Fleifel D, Waheed M, Vaidya R. Mentorship in a Surgical Residency: A Comprehensive Review of the Literature. Cureus. 2023;15(8):e43422. Published 2023 Aug 13. doi:10.7759/cureus.43422 

How to have a successful mentor-mentee relationship 

Building a successful mentor-mentee relationship is a vital component of professional growth and development. In this section, we provide some actionable tips to help you cultivate a fruitful partnership with your mentor, ensuring mutual benefit and growth.

1. Be prepared for meetings by anticipating questions or challenges – set clear agendas.

2. Act on your mentor's advice and suggestions to demonstrate commitment – ask questions as you go to ensure clarity of action.

3. Maintain open communication about progress and developments – find ways to track and measure goals.

4. Foster a personal connection by showing genuine interest in their lived experiences, research areas, and/or clinical specialty.

5. Communicate and co-regulate through any potential tensions. 

6. Stay flexible with scheduling while striving for consistency.

7. Share your learning journey and personal insights to enrich the relationship.

8. Express gratitude for your mentor's guidance to strengthen the bond.

As viewed from both the mentor and mentee angles, the effectiveness of a mentorship program relies on three essential elements: the expected objectives of the mentorship bond, the attributes of the participants involved, and the framework of the program.

How to get involved  

Initiatives and programs that offer opportunities for mentorship include various organisations dedicated to advancing gender equity and supporting women in the medical and surgical fields. Some notable examples are:

1- Gender Equity in Global Surgery (GEIGS): https://gendereqglobalsurg.wixsite.com/geigs 

2- Association of Women Surgeons (AWS) :https://www.womensurgeons.org 

3- International Student Surgical Network (InciSioN) :https://incisionetwork.org 

4- The American College of Surgeons (ACS) :https://www.facs.org 

5- Women in Surgery Africa (WiSA) :http://www.womeninsurgeryafrica.org 

Conclusion

From my perspective, mentorship is a cornerstone of global surgery, offering invaluable benefits to both mentees and the broader surgical community. It provides aspiring surgeons, including women, with essential guidance and support to navigate the complexities of surgical practice in resource-limited settings. Through mentorship, mentees gain access to valuable insights, techniques, and best practices, enhancing their professional development. Additionally, mentorship fosters collaboration within the global surgical community, facilitating knowledge exchange and capacity-building initiatives crucial for addressing healthcare disparities. For women in global surgery, mentorship offers a unique opportunity to access networks and opportunities for research collaborations, furthering their academic and professional growth, as I have experienced personally in my journey as well.

References and further reading

• Clutterbuck D. Everyone needs a mentor, 4th ed. London: Chartered Institute of Personnel and Development; 2004. https://dx.doi.org/10.1016/b978-0-7506-3695-7.50002-0 

• Abudayyeh I, Tandon A, Wittekind SG, et al. Landscape of Mentorship and its Effects on Success in Cardiology. JACC Basic Transl Sci. 2020;5(12):1181-1186. Published 2020 Dec 23. doi:10.1016/j.jacbts.2020.09.014

• Luc JGY, Stamp NL, Antonoff MB. Social media in the mentorship and networking of physicians: Important role for women in surgical specialties. Am J Surg. 2018;215(4):752-760. doi:10.1016/j.amjsurg.2018.02.011 

• Singh C, Loseth C, Shoqirat NWomen in surgery: a systematic review of 25 yearsBMJ Leader 2021;5:283-290.

• Umoetok F, Van Wyk JM, Madiba TE. Does gender impact on female doctors’ experiences in the training and practice ofCochran A, Neumayer LA, Elder WB. Barriers to careers identified by women in academic surgery: A grounded theory model. Am J Surg. 2019;218(4):780-785. doi:10.1016/j.amjsurg.2019.07.015

• Zhuge Y, Kaufman J, Simeone DM, Chen H, Velazquez OC. Is there still a glass ceiling for women in academic surgery?. Ann Surg. 2011;253(4):637-643. doi:10.1097/SLA.0b013e3182111120

• Makama JG, Garba ES, Ameh EA. Under representation of women in surgery in Nigeria: by choice or by design?. Oman Med J. 2012;27(1):66-69. doi:10.5001/omj.2012.15

• de Costa J, Chen-Xu J, Bentounsi Z, et al.. Women in surgery: challenges and opportunities. IJS Global Health 2018;1:e02.

• Garvey B. Philosophical origins of mentoring: The critical narrative analysis. In: Clutterbuck DA, Kochan FK, Lunsford L, Dominguez N, Haddock-Millar J, editors. The SAGE handbook of mentoring. London, UK: SAGE Publications; 2017. 10.4135/9781526402011.n2.

• Buddeberg-Fischer B, Herta KD. Formal mentoring programmes for medical students and doctors--a review of the Medline literature. Med Teach. 2006;28(3):248-257. doi:10.1080/01421590500313043

• Frei E, Stamm M, Buddeberg-Fischer B. Mentoring programs for medical students--a review of the PubMed literature 2000-2008. BMC Med Educ. 2010;10:32. Published 2010 Apr 30. doi:10.1186/1472-6920-10-32

• surgery? A single centre study. S Afr J Surg. 2017;55(3):8–12.

• Yi S, Lin Y, Kansayisa G, Costas-Chavarri A. A qualitative study on perceptions of surgical careers in Rwanda: a gender-based approach. PLoS ONE. 2018;13(5):e0197290. 

• Mendler, A., 1994. Teaching Hard-to-Reach Youth. Journal of Emotional and Behavioral Problems, 3(2), pp.23-24.

• https://www.togetherplatform.com/blog/how-to-build-a-successful-mentor-relationship 

• https://www.togetherplatform.com/blog/building-an-authentic-connection-when-mentoring 

• Enani GN, Brydges R, MacRae HM,Louridas M. Exploring mentorship in surgery: An interviewstudy on how people stick together.Med Educ. 2023;57(11):1028‐1035. doi:10.1111/medu.15157ENANIET AL.1035 

• Steelman K, Fleifel D, Waheed M, Vaidya R. Mentorship in a Surgical Residency: A Comprehensive Review of the Literature. Cureus. 2023;15(8):e43422. Published 2023 Aug 13. doi:10.7759/cureus.43422
  

Dear Fearless Sisters..

International Women's Day (IWD) is a global day celebrating the social, economic, cultural, and political achievements of women. Since 1911, March 8th has marked a call to action for accelerating women's equality.It also serves as a call to action for advancing women's equality. The goal of the IWD 2024 #InspireInclusion campaign is to collectively forge a more inclusive world for women, aligning with this year's theme of Inspire Inclusion.

For the celebration of IWD 2024 and #InspireInclusion campaign, our team member Eilene Basu (WPRO regional lead) has penned down a beautiful letter for all the "Fearless Sisters" out there🌟 At GEIGS, we're proud to stand alongside women in global surgery and advocate for a world where everyone is included and empowered. Let's work together to create a future where gender equality thrives 💜

Join our #IWD Campaign championing women's achievements and promoting gender equality. #IWD2024 #GenderEquality #GEIGSforIWD 🌍♀️✊

Diversity, Equity, and Justice in Global Surgery

By Rabbey Raza, DEJ Lead

What is Diversity, Equity, and Justice?

Recent years have seen increased attention to efforts for addressing underrepresentation in medicine and surgery, lack of diversity among healthcare professionals, and health disparities within different populations. One such approach is the development of committees and task forces focused on Diversity, Equity, and Justice (DEJ).

Diversity refers to the representation of individuals from diverse and varied backgrounds and identities. These may include but are not limited to, gender, race, ethnicity, religion, geographic location etc. The main goal is to ensure that the global surgical workforce represents the diversity of the population it is currently serving. Having a diverse workforce also allows for cultural competency and improved patient care. 

Equity reflects that all individuals have access to surgical care and resources, irrespective of their backgrounds. Equity efforts involve reducing barriers to surgical services, advocating for improved healthcare infrastructure in underserved areas, and promoting fair distribution of surgical resources. 

Justice in the DEJ context pertains to addressing systemic injustices and advocating for policies and strategies that uphold social justice principles. This involves challenging inequitable power dynamics and advocating for the rights of underrepresented populations. It also promotes ethical and sustainable practices in surgery. Gender-based violence, discrimination, and exploitation within surgical settings can all be discussed under the justice portion of DEJ.

Why does DEJ matter?

DEJ is essential for fostering inclusive, equitable, and just environments where all individuals can thrive irrespective of their background or circumstances.

Equal opportunities

DEJ promotes fairness amongst all individuals and advocates acknowledging, recognizing, and celebrating individual backgrounds, cultures, races, genders, ethnicities etc. It strives to mitigate barriers experienced as a result of these diverse identities. It promotes the fact that everyone should have an equal chance to succeed and thrive.

Confronting structural inequities

DEJ aims to first identify the structural inequalities and discriminatory policies and then proceed to dismantle them at their roots. It does so by actively challenging biases, emphasising mutual respect and dignity, and making the voices of underrepresented minorities head on national and International platforms. By identifying inequalities that are deeply entrenched within systems and then challenging them, DEJ fosters equal opportunities for conventionally underrepresented groups. It also ensures that they are treated fairly to foster a more inclusive and just society for all, creating a safe space in an organisation for the discussion of any issues that may arise.

Inclusivity and Representation

DEJ ensures that diverse voices, from diverse groups of people are prioritised when it comes to leadership and decision-making processes. These different viewpoints can not only foster creativity and motivate innovation but also contribute to more practical, relevant solutions. Valuing a diverse group of people in decision-making processes also helps create a more just society, and encourages acceptance regardless of differences.

How to incorporate DEJ into your daily practice?

There are several strategies you can adopt for incorporating DEJ into your practice as a healthcare professional.

Cultural competency workshops and training

If you are in an administrative or decision-making position in your institute, organising frequent cultural competency training can serve as a foundation stone for incorporating DEJ. On an individual level, you can also seek out e-learning modules to educate and train yourself. 

This training could include modules targeted towards understanding a diverse range of cultures, values and practices. Such training modules often emphasise the importance of small changes - such as respecting an individual’s personal pronouns - in creating inclusive environments. Ensuring that healthcare professionals understand and value different cultures and identities will also help improve communication within teams and with patients, and consequently improve workplace dynamics and patient outcomes.

Mentorship and Support

You can take an active role in mentoring healthcare students from diverse and underrepresented backgrounds. This strategy, while applicable at the institutional level, is also very practical at the resident and junior doctor levels. Mentor and support colleagues and students from diverse backgrounds by offering them guidance, exposure, resources, and opportunities for professional development. This will foster a supportive environment within the workplace and continue to advance a diverse set of talents in your field. Offer equal opportunities to all regardless of their backgrounds.

At the institutional level, hospitals and universities can introduce mentorship programs that are specifically meant for students and residents from diverse and underrepresented backgrounds. Joining student societies and working groups that share your identity is another way of finding solidarity and peer-led support and mentoring.

Participate in Research and Advocacy

You can actively engage in research and advocacy projects that aim to address racial, gender, or cultural disparities in medicine and surgery. Another way to get involved would be to conduct community-based projects for identifying disparities, and healthcare needs. Once identified, strong advocacy campaigns could be launched that advocate for policy changes at various levels. Social media is a powerful tool and no advocacy campaign is too small!

Another way to get involved in research and advocacy would be to become a part of organisations that prioritise this. GEIGS is one such organisation. We aim to address gender disparities in global surgery and advocate for policy changes and implementation of sustainable strategies for greater inclusivity.

Conclusion 

DEJ initiatives promote inclusivity, fairness, and equal opportunities for all Individuals irrespective of their backgrounds. By incorporating DEJ into your daily practice, both on the individual and institutional level, you can ensure that your workplace is inclusive and just, with better patient care and overall a more respectful environment for everyone.

Further reading

1. Meara, John G., et al. "Global Surgery 2030: Evidence and Solutions for Achieving Health, Welfare, and Economic Development." The Lancet, vol. 386, no. 9993, 2015, pp. 569-624.

2. World Health Organization. "Global Initiative for Emergency and Essential Surgical Care." 2021. https://www.who.int/surgery/en/.

3. Betancourt, J. R., Green, A. R., & Carrillo, J. E. (2002). Cultural competence in health care: emerging frameworks and practical approaches. The Commonwealth Fund

4. Braveman, P., & Gruskin, S. (2003). Defining equity in health. Journal of Epidemiology & Community Health, 57(4), 254-258.

5. National Institutes of Health. (2021). National Institute on Minority Health and Health Disparities.

6. Association of American Medical Colleges. (2019). Diversity in medicine: Facts and Figures 2019