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By Tinsae Abera Worku

(Edited by Riya Sawhney )


Global surgery is a multidisciplinary field that was, in a manner, formalized in 2015 after the World Health Assembly resolution 68.151. The field aims to provide equitable surgical care worldwide and works to address the need, access, and quality of surgical care through study, research, practice, and advocacy [1]. Historically, the field has been under-prioritized, however, recently it has been effective in rallying people together to work towards increasing access to safe, affordable, and quality surgical services for 5 billion underserved people, primarily residing in low- and middle-income countries (LMICs) [2]


Research is one of the main grounding components of global surgery because of its pivotal role in driving innovation and health system strengthening in the field. Nevertheless, despite the fundamental nature of research to global surgery, gaps still persist, stifling equity in this sector. The disparity is particularly striking in LMICs, where research output is considerably lower compared to high-income countries [3]. Furthermore, even though equity is one of the field's core principles, there is a stark underrepresentation of women researchers globally. There is a significantly low representation of women authors, which at times has been as low as 9% of abstracts presented at international conferences [4]. This underrepresentation highlights a broader issue: without urgent action, achieving gender parity in academic global surgery—where women would comprise 50% of full professors—may remain a distant dream, stretching as far as 2096 [5,6].



Suffice it to say that evidence indicates the emphasis on the representation of women in global surgery is a relatively recent development [7]. Over the years, although the number of women in this field has steadily grown, research still shows that women in surgical fields occupy fewer leadership roles, participate less in research, and receive lower grant funding compared to their male counterparts6. Due to deeply entrenched structural, cultural, and social challenges including the novelty of the field, there is a dearth of established faculty members who can provide mentorship and female role models, leaving many junior researchers without support [8]. Furthermore, persistent 'old boys club' attitudes and unequal pay, hamper the progress of aspiring female surgeons6. These challenges, compounded by the systemic barriers women face in political, cultural, and economic contexts, perpetuate a cycle of underrepresentation, and limit the diversity of perspectives in global surgery research. 


Women researchers have been at the forefront of advocating for women's health issues, including maternal mortality and access to obstetric care in low-resource settings. This contributes to better quality of care because of the lived experiences they bring to the table8. Recent studies have shown that female clinical researchers are more likely to include female study participants, addressing historical underrepresentation in research subjects. With their increased presence, surgical spaces are enriched by a shift in focus towards overlooked, often exclusively female, health conditions [8]. Moreover, increasing on-ground representation of local women in global surgery research enables the development of context-specific solutions, promotes equity in research participants recruitment, and addresses sensitive health considerations for female patient populations [9]. Furthermore, the inclusion of women in the surgical environment creates a more welcoming and cooperative atmosphere, enhancing collaboration and innovation for the whole team [8]


While there has been a commendable rise in publications authored by women in global surgery literature, there is still a lot that needs to be done to bridge the gap [10]. It is time to eliminate barriers hindering women's advancement in global surgery research and ensure their increased representation. Efforts from all relevant stakeholders are imperative to drive meaningful inclusion of women in global surgery research. Simply maintaining the status quo is not an option; proactive measures are needed to effect change and achieve gender parity before 2096. 


Addressing these challenges requires concerted efforts, starting with acknowledging the current gaps. A comprehensive systemic approach is essential for accelerating gender equality, with initiatives such as leading research training focused on global surgery projects. Truly meaningful research collaboration and mentorship that include women as the influential first and last author positions on collaborative manuscripts, principal investigators on grants, and visiting professorships to deliver lectures beyond quotas should be employed. Integrating gender-sensitive approaches into research design and analysis ensuring the needs and perspectives of women are adequately represented is also another possible solution. Additionally, safety remains paramount, therefore robust safety monitoring mechanisms alongside mitigation and accountability actions are crucial to address gender-based violence during research, especially for research conducted in novel or under-resourced settings that require women to travel and work in a new environment.


Going forward, we need to closely monitor authorship trends in the field to identify areas that need priority support. We should also hold journals and funding organizations accountable for their equity metrics. Additionally, it is crucial to celebrate the achievements of women in this field, creating supportive environments that value diversity and inclusivity, inspiring future women researchers. Moreover, we must join forces with organizations like Gender Equity Initiative in Global Surgery (GEIGS) to advocate for systemic change and dismantle barriers that hold women back. Only then can we create an environment where all aspiring women researchers have equal opportunities to succeed and contribute to the advancement of global surgery research.


The inclusion of women in global surgery research brings invaluable benefits to the social, political, and economic aspects of society. Despite comprising a small proportion of principal investigators, the quality of work presented by women in conferences equals or surpasses that of their male counterparts [4]. Research demonstrates that diverse teams, inclusive of women and other minorities, consistently outperform homogeneous teams [11]. Their indispensable contributions underscore the importance of diverse teams in producing higher-quality outcomes and driving innovation. Consequently, women's voices in global surgery research are imperative in improving the quality and impact of research outcomes. As we strive to advance surgical care worldwide, let us commit to fostering an environment that values and amplifies the contributions of women. By doing so, there is a plausible chance of achieving gender equity in academic global surgery well before 2096, and we can create a more inclusive and effective global surgical community that serves the needs of all patients, regardless of gender.



Reference 

1. Ravi K, Bentounsi Z, Tariq A, Brazeal A, Daudu D, Back F, et al. Systematic analysis of authorship demographics in global surgery. BMJ Glob Health. 2021 Oct;6(10):e006672. 

2. Bath M, Bashford T, Fitzgerald JE. What is ‘global surgery’? Defining the multidisciplinary interface between surgery, anaesthesia and public health. BMJ Glob Health. 2019 Oct;4(5):e001808. 

3. Kebede MA, Tor DSG, Aklilu T, Petros A, Ifeanyichi M, Aderaw E, et al. Identifying critical gaps in research to advance global surgery by 2030: a systematic mapping review. BMC Health Serv Res. 2023 Sep 4;23(1):946. 

4. Housri N, Cheung MC, Koniaris LG, Zimmers TA. Scientific Impact of Women in Academic Surgery. J Surg Res. 2008 Jul;148(1):13–6. 

5. Sexton KW, Hocking KM, Wise E, Osgood MJ, Cheung-Flynn J, Komalavilas P, et al. Women in Academic Surgery: The Pipeline Is Busted. J Surg Educ. 2012 Jan;69(1):84–90. 

6. Balachandran G. Women Empowerment in Surgery – Do Women Need ‘Special Treatment.’ J Med Evid. 2024;5(1):71–4. 

7. De Costa J, Chen-Xu J, Bentounsi Z, Vervoort D. Women in surgery: challenges and opportunities. Int J Surg Glob Health. 2018 Jul;1(1):e02–e02. 

8. Busa I, Nagraj S. Women as a driver to address gaps in the global surgical workforce. Hum Resour Health. 2023 Mar 16;21(1):22. 

9. Dutta R, Coombes C, Ehsan A, Bryce-Alberti M, Campos LN, Raguveer V, et al. Unleashing the potential of women in global surgery: Concrete solutions for achieving gender parity. Robinson J, editor. PLOS Glob Public Health. 2024 Apr 4;4(4):e0003018. 

10. Padmanaban V, DaCosta A, Tran A, Kunac A, Swaroop M, Zhang WW, et al. Closing the Gender Gap in Global Surgery: Trends at the Academic Surgical Congress. J Surg Res. 2021 Jan;257:389–93. 

11. Graner M, Buda AM, Moura CB, Campos L, Faria I, Truche P, et al. Is authorship by women in Brazilian academic surgery increasing? A five-year retrospective analysis. Sriram V, editor. PLOS Glob Public Health. 2022 Apr 27;2(4):e0000294. 


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Mary Magdi, Education Lead

(Edited by Riya Sawhney , GIEGS Co-Chair )


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

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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 🌍♀️✊





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