Good evening. On behalf of ALFAS and ARCHALS, I want to welcome you to tonight's program, presented in collaboration with the Ruth Jackson Orthopedic Society. ALFAS, on the same page, advocacy for women in orthopedics. Our chairs tonight are Michelle M. Coleman, MD, PhD, and Lubna Zayildin. You can find their disclosures in the program document posted in the chat box down the PRC. Funding for the ALFAS Diversity, Equity, and Inclusion Initiative is provided by the Orthopedic Foot and Ankle Foundation, supported by a grant from Stryker. I'd like to run through a few housekeeping items before we kick off the presentation. For technical difficulties, please try closing your browser and logging back in the same way you did the first time. If you need to contact us as ALFAS staff, please contact us in the chat box. Registered physician attendees may earn 1.5 hours of AMA, PRA, Category 1 CME credit by completing an evaluation in CME claim form at the end of the webinar. You can find the link to Claim CME in the chat tab at the following of this broadcast, and we will also follow up with an email. This webinar is being recorded and will be available for on-demand viewing in approximately one week. I will now turn the program over to Chairs Dr. Michelle Coleman and Levna Zeldin for introductions. Thank you. Hello, everybody. I would like to again formally welcome you to this webinar on behalf of the American Orthopedic Foot and Ankle Society, as well as the Ruth Jackson Orthopedic Society. The title of our webinar tonight is Advocacy for Women in Orthopedics. So she already introduced us, but my name is Michelle Coleman. I'm an assistant professor and one of the Associate Residency Program Directors at Emory University in Atlanta, Georgia. Hi, everyone. My name is Levna Zeldin. I'm a third-year medical student at the University of Illinois College of Medicine, and I am from the Ruth Jackson Orthopedic Society DEI Task Force. So we're both representing our respective organizations, Diversity, Equity, and Inclusion committees, and we're really excited to have this webinar with you. As you know, as many people on this webinar already know, orthopedics, unfortunately, is the least diverse specialty of all the medical specialties. Only 6% of orthopedic surgeons are women and 16% of orthopedic surgery residents are women. So there's a real need to, you know, understand why this is, to figure out what are the barriers to women in orthopedic surgery, and to kind of talk about steps forward. The AAOS, the AOFAS, and Ruth Jackson Orthopedic Society and other national organizations have drawn attention, you know, to this area of gender disparity. And there are several different articles that have come out over the last 10 years talking about this gender disparity as well. So today for our event, this is sort of our outline. We'll start with a journal article discussion, and we have two specific articles that we're going to be talking about. Now, there was no pre-reading required whatsoever, and we'll be kind of bringing the salient points to you and posing some questions that we really hope that you'll get involved with, that you'll be willing to speak up, you know, share your own experiences, raise your own questions, or give your own answers. And you can do that either by unmuting yourself and, you know, just speaking up right in the moment, or you can put a question or an answer in the chat box as well. And we'll be paying attention to that throughout. After the journal article discussion, we're also going to be having a special appearance by the Bowdoin family of orthopedic surgeons who are quite remarkable people. And this is the family of orthopedic surgeons that we were talking about. They're all on the on the call already, and they will speak up sort of throughout, but most of the discussion will be towards the end. So we have Dr. Scott Bowdoin, who's the chairman of the Emory Orthopedic Surgery Department. And we have his four daughters who are all orthopedic surgery residents, Lauren Bowdoin, who's a PGY-5 at University of Pennsylvania, Allison Bowdoin, who is a PGY-5 at University of Miami, Stephanie Bowdoin, who's a PGY-5 at the University of Pittsburgh, and Suzanne Bowdoin, who's a PGY-3 at the University of Pittsburgh. In terms of ground rules for this event, please be mindful when you're speaking so that everyone has a chance to speak who wants to. And you know, if the discussion is getting very long, we may actually have to cut off certain discussion to keep moving. Listen to understand not to respond. And please just, you know, everyone validate each other's experience. We all come from different places. And you know, one point of view is not correct over another one. Let's just be very open as we have these discussions. In terms of logistics, everyone, if you're not currently speaking or contributing to the discussion, if you don't mind muting yourself, that would be wonderful. But please feel free to unmute at any point to add to the discussion, answer questions, or raise questions. But again, if you're in a loud place, and you don't want to unmute for some reason, also feel free to post questions or discussion in the chat box. With that, we will get started with our journal article discussion. Hi, everyone. Once again, my name is Libna. The first article that we chose for today's discussion was next steps advocating for women in orthopedic surgery. And what we thought was really great about this article was that not only did it discuss women in orthopedics, in areas within orthopedics that many women have expressed difficulties in, but it really highlighted a lot of ways in which changes can be made in diversity can be advocated for in orthopedics. So the first figure that we saw in this article, and it kind of encompassed the first kind of section in this article was that they wanted to highlight female orthopedic surgery or female orthopedic surgeons in academics in comparison to other specialties, such as ENT, general surgery and ophthalmology. And what really struck us from this article was that they mentioned that women account for only 18% of full-time orthopedic surgery faculty, and they hold disproportionately lower academic titles than men. And as you can see in this graph, when it comes to instructors, we have about a little less than 40% of women represented as instructors for orthopedic surgery. And it is already a little lower than the rest of the specialties represented on this graph. But what really struck us was that as you continue on higher up from instructor to assistant professor, associate professor, professor chair, that number really rapidly declines and it's a drastic decrease in comparison to all other specialties. And when you look at the chair positions, only nine women were named orthopedic department chairs since 2015, and only two were before 2020. We've only had one female orthopedic surgeon president of AOS, and only eight have been president out of one of 23 AOS Board of Specialty Societies. So at this time, we'd like to open up for discussion and get everyone's thoughts on, you know, what are some barriers that either you or other women have experienced in promotions or academic titles? And please feel free if you feel more comfortable dropping in the chat or unmuting yourself, whatever is most comfortable. Do these numbers ring true to everybody here who is in academics. I would say these numbers ring true at Emory even though Dr Bowdoin is doing his best to recruit. I would say they wouldn't ring true, certain yes. I agree. It's about the same for University of Cincinnati. Dr. Archdeacon is definitely trying to change that like Dr. Bowdoin. I don't know if it's true for other institutions, but recruiting women into academics. A lot of our female residents go into private practice. I think out of the several that have come through while I was a resident, only three of us have gone into academics. Everybody else has gone into private practice. I don't know if any other women can comment on that. Maybe it's a better lifestyle in private practice rather than academics. I'm not sure. I think that's a common mantra and a common excuse. Tanya, I get that that's how it is in your program. It's Holly. I know so many academic women who aren't promoted. There's so many women at my institution who aren't leaders of any departments. In fact, in the major surgical departments, there are no women, even though we have a lot of women on staff. That was also true at my prior institution, which is another large orthopedic place. I think that it's a common mantra that there aren't enough women to choose from. I hear about that in virtually every time I talk about advancing women. I think that that's a cop-out. I think that for every woman that goes into private practice, there's a man who goes into private practice. It's just that the women aren't in the room for the discussions. I think the other thing that you have to recognize is that if you don't show this data side by side with retention data, then it's not as clear what this means, because it could mean that women aren't being promoted. It could also mean that women are leaving academics earlier in their career as a result of negative work experiences or potentially other things. They're not making it to these higher levels, associate or full professor, not because they wouldn't have been promoted potentially, but because they left. Without retention data, I think it is hard to understand exactly what these numbers mean. That's definitely a fair point. I'm actually interested to know. I know you mentioned earlier why that shift between private practice and academics. Something that I always wondered when I had seen this figure was, why is it so much more different for orthopedics than these other specialties, like ENT and general surgery and ophthalmology? Because when we look at this graph, there already is a lower amount of women, but the trend is so much more significant for orthopedics than it is for any other specialty. This is Sandy Klein again. This data is not data that I was ever able to publish. I did go through and look at AAMC data for all specialties to understand promotion, retention, and other aspects of women versus men in academic medicine. That data over a 20-year period that was probably from 1990 to 2010 essentially showed that proportionally, actually, lots of women go into academics in orthopedics. If the percentage of residents who were women was around 13 to 15%, the percentage of women who actually went into academic medicine in orthopedics was actually 20 to 25%. I think it's just that there's so few women. It's just there's not that many of us, so it's going to be hard for any one institution to recruit a significant number. This is Daniel Gus from Boston. I'm just curious, why do we still feel that so few enter? I've always felt that that idea of lifestyle or something like that is a very serious cop-out because when you look at fields like general surgery, most of the people on this call were dying to finish their general surgery internship so they could move on to orthopedics. Yet general surgery recruits a lot of women. The idea that somehow this is a lifestyle issue that then we extend to the academic versus private practice conversation I think is inherently a fallacy. There's plenty of very difficult fields that attract plenty of women. That's why I'm trying to understand, is there a legacy cost? Is there some sort of reputational history that we still carry or cannot shake? I'm curious what people think about that. Hi, this is Lorena Pineda. Regarding to what Daniel Gus is mentioning, I feel in some ways that's true about lifestyle and other different aspects that we can see in other specialties that are as hard as it is in orthopedics. I feel part is maybe one is the reputation but also the culture in terms of sometimes in some programs there is still a lot of that brother culture. Women feel like they are not going to be as welcome on others. When they see in other programs where they're a little bit more balanced and more open, even if they have to work hard, but they just feel more welcoming. They're willing to just have a very hard work lifestyle, but just being a little bit more welcoming in their environment. Just for the sake of time, we are going to move forward, but we will, if we have time at the end, come back and address some of these comments and questions. For the next part of this article, we wanted to highlight was they mentioned that the AAOS leadership came up with this strategic plan between 2019 and 2023. This was specifically to target board membership and volunteer structure. They came up with these four tenets that we thought were very interesting. Recruitment, selection, retention, and culture. Recruitment for targeting and focused recruitment of underrepresented minorities and women. Purposeful and transparent selection. Enhanced retention of women and underrepresented minorities in the AAOS volunteering structure, onboarding, mentoring, and leadership development. This overall culture of just promoting an orthopedic culture that embraces diversity, inclusion, and equity for AAOS membership. Throughout that, in the article, they do talk about how AAOS specifically has partnering with societies such as the Ruth Jackson Orthopedic Society, Cladden Society, the American Association of Latino Orthopedic Surgeons. In the article, they mentioned that more than 90% of AAOS leadership and staff liaisons have completed DEI and implicit bias training. So I'd love to open it up for these organizations such as AAOS that have been working on DEI. What efforts do you feel have been successful and where do you feel there can still be improvement? On the topic of bias training, you know, that's something that we've, you know, been doing at Emory, especially for any faculty members who are going to be going through the interview process, you know, interviewing med students for residency positions, and, you know, the problem with some bias training is, like, you know, people will show up, not really pay attention, maybe not get a lot out of it, so it's kind of hard to check a box for bias training and really know what the impact's going to be. I think, for me, what's been most helpful with bias training is taking the tests, you know, so you can actually see what your own biases are, and then you can be dismayed when you're an advocate for women in orthopedic surgery, and yet you still have biases against women. So I think that's, you know, the most telling and the most helpful to just kind of see where you are, you know, in this road of us becoming, you know, less biased. I think it helps. I think it's good to do. I don't know what the impact is on the national level, but I think it's good culturally, at least on the institutional level. Has anyone else had DEI or implicit bias training at their institutions and similar to Dr. Coleman's had either a positive or a negative experience? Tanya, again, we have and I agree with Dr. Coleman and that I think it definitely has helped, but I personally have taken more out of it. I can't speak to my, you know, partners and how much they're getting out of it. But I echo what, you know, Dr. Coleman is and I and what we're doing with the AOFAS I think has definitely helped me too, because, you know, the books that we've read on diversity as well as, you know, women in medicine, I'm listening more to my patients, whereas before I would just say, oh, no, they're, they're crazy or something like that. You know, I feel like I'm changing for the better. And so, you know, I focus on me and then try and instill that with, you know, the residents and stuff like that. And hopefully, you kind of implement that change slowly, you know, unfortunately, it's not going to happen overnight, but, you know, you just start with you and try to, you know, make it a little bit better for, for those that are after you. Is anybody who's involved with these, you know, national organizations in a board position, you know, seen any positive changes, you know, or anything that's worked or, you know, have any, any insight from that higher level, not the institutional level? After Canada, I see that you have your hand raised, you can feel free to unmute. Okay, I did I just was trying to follow the zoom things, you know, having been on the board of several organizations including the Academy the OTA and RGOS. In the past and now again, I think you are seeing a difference, you are seeing a concerted effort to recruit women, and to reach out and to also ensure there's minorities it's not just women diversity doesn't just mean women it means diversity in practice diversity in thought diversity in workplace diversity in sexual orientation and that, to me, is, you know, a broader acceptance of everybody in orthopedics to better treat our patients better understand the issues in training, so that we can make the path better for those that follow. So I think there's increased awareness to concerted effort. And one way to do that is the accountability, the accountability of providing an annual report, and the diversity of the DAB diversity advisory board for the Academy has a report you can just click on that on the website it tells you the women in leadership positions, the women that have applied minorities that have applied because we got a, you know, far reaching group, and it gives those statistics so I think if everyone talks to talk they got to walk the walk and show with the show what happens show you know your diversity report, and I really commend the AOFAS for the work you have done last year I attended your women in orthopedics event, and I was it was fascinating and the efforts that you made the awards you've given and the recognition that you give that's important we need to raise each other up, raise the minorities up to whether it's minority gender race or whatever, raise them up and elevate them. And then when we see more faces, when everyone sees those faces, that's going to, you know, have a far reaching effect. So that's my two cents on the process. Thank you so much, Dr. Canada, you bring up a really important point, especially when it comes to representation, I had the opportunity of attending AOS earlier this year and I was very very motivated and inspired with the amount of women and minorities that I had seen on that podium. Moving on. One of the aspects that we wanted to kind of highlight from this talk, or from the article that we had read, was that they did a really great job of kind of highlighting sexual harassment, and how much of a big difficulty it is for women in orthopedics facing. And what they did in the article was that they drew an analogy to this iceberg, where in the iceberg at the top that you can see you can see those very plain and egregious acts of you know sexual assault unwanted groping or stroking, but they do. And I also really want to highlight how beneath that iceberg there are things such as offensive sexual teasing offensive remarks about bodies, sexist insults gender slurs vulgar name calling that are still considered sexual harassment they're just kind of underneath the surface and not taken as seriously. And in this article they do highlight a statistic of 68% of female orthopedic surgeons have reported, having been victims of sexual harassment during residency training. So I'd love to open up the discussion for anyone who'd like to kind of say their opinions and have anyone ever been involved in helping a victim of sexual harassment. Did you feel as if your institution had the correct kind of guidelines and restrictions and kind of process put in place to adequately handle it. I think what we see in all of this, and I think the same article that reported this about people who reported being harassed, is that this goes under-reported. And there's a fear of reporting, because I think there's a very high incidence of retaliation when a woman reports that she's being harassed. And I also think that there's a very frequent sort of victim-blaming or lack of belief of the woman and her story, as you see with lots of types of sexual assault or sexual harassment, where somehow the victim has the burden of proof in terms of whether or not this actually happened to her. So I think we see it all. And, you know, getting to a place where it's safe for women to report what has happened to them should be a top priority within our institutions. But that's a big barrier to really understanding and starting to solve this problem is creating safe spaces for people to report. And Dr. Canada? More importantly, Sandy brought up an incredible point, the fear of retaliation and reporting, but more importantly, there has to be consequences. Otherwise, the braveness of the people that went and reported this and the braveness of those that stick up for them, if there are no consequences for these acts, then there is a problem. So I think all the things, sexual harassment, bullying, discrimination, all fall into this, you know, problems in the culture of orthopedic surgery, but sexual harassment is a crime. And if you witness it, you are obligated to report it. So let's think about that. It's a crime, and people report it and get away with it. So that's the, you know, we are creating safe avenues for reporting, but we also need to ensure that there's consequences so that those that are brave enough to tell their story feel like it was, you know, definitely listened to. I know Dr. Canada and Dr. Klein, you both mentioned having those safe avenues. Would anyone like to share, at least for their institutions, what avenues or places that they have for women who, if they want to speak up, they have been able to go through either successfully or unsuccessfully? This is Dawn Lepore. We have an ombuds program, which is a resource for people to report outside of their department if they're uncomfortable reporting to the people that they work with, and there's also a peer support network. I have had the unfortunate, I guess, opportunity to work with a trainee at another institution who had the, you know, who was brave enough to report a really terrible situation and did experience retaliation and bumped up to the ACGME, which is appropriate in training, but steps weren't taken. I think, as Dr. Canada and Dr. Stein just mentioned, unfortunately, we see that a lot, and that's, I think, an area that needs to be better, that there are steps that are taken to address this. I think some of the, this is Michelle Coleman speaking, I think some of these sort of things that are under the surface, under the gender harassment section, especially some of the ones Lubna mentioned at the bottom, you know, so let's say sexist insults or offensive remarks about bodies, offensive sexual teasing, I think that some of that goes back to culture, like Dr. Panetta was talking about before, is that, you know, orthopedics has traditionally had this locker room mentality, and, you know, the men, really in all surgical specialties, but especially in ortho, have been able to sort of get away with a certain style of, you know, talking and interacting, which, you know, they don't, I think sometimes the men don't even realize it's offensive. You know, so they may make some, you know, sort of crude comments about, you know, a patient, a female patient and not realize that those comments might be offensive to a female resident who maybe has a similar body type, or who's also a woman and feels like those comments were inappropriate. So some of it is, I think, at the faculty level, you know, educating the men, hey, you know, or even at the resident level as a peer to peer saying, hey, like, that's not cool. You can't do that anymore. You gotta, you gotta chill out with that type of talk and those kinds of jokes. And I think the men, you know, I'd like to give the benefit of the doubt to most of them that they just are ignorant or they, you know, they don't mean to be offensive at all, but that we just need, you know, we need them to learn and to move forward. And Dr. Laporte brings up a very important point in the chat. And wrapping up this article, they kind of end with a summary of strategies that they kind of recommend for increasing diversity and increasing women in orthopedics. And we kind of wanted to just summarize a couple for you all. The first one was early exposure and hands on experience at the medical student level to give exposure to role models and potential mentors within orthopedic surgery, especially for those who have no means of interfacing with an orthopedic surgeon who looks like them. And as someone, as a medical student myself, I can't even begin to explain how valuable it is and how meaningful it is to see an orthopedic surgeon and have a mentor of someone who looks like me. Another point of strategy that they mentioned in this article is cultural transformation. And I think this is something that we've hit on kind of throughout the article is that in order to kind of address these barriers to career advancement for women, we really have to address these barriers at both or at all levels, including individual, interpersonal, institutional, academic, and policy levels. It's only until we kind of start to put these or we acknowledge that these barriers are in place and transform that culture that we can move forward. And finally, for institutions, organizations, and practice to adopt a zero tolerance policy when it comes to sexual harassment, because we do need to hold those accountable. And it's only when we speak up and we hold those who are accountable and we hold people accountable to their actions that we can start to kind of recognize that implicit bias and have it more readily recognized and dispelled. And these are just three of the strategies that are mentioned in this article. We'd love to, you know, see, get your thoughts. Has your institution or organization applied these strategies? And what was the result? I think there's, this is Michelle Coleman speaking I think there's good data behind sort of that early exposure and hands on experience through programs like the Perry initiative, and the end dimensions bioskill sessions. I wish I would have participated in one of those as a medical student I didn't but I think that that would have been really inspiring to me along the way. But, you know, for me what what helped me to want to go into orthopedics was early exposure to a female surgeon, you know, female orthopedic surgeon and seeing what they did and sort of being just excited about what orthopedics is and not really seeing being woman as a barrier necessarily initially, and kind of learning more about the barriers as I after I already had a little bit of interest in orthopedics. So I think that helped for me and I think, you know, Emory we have a summer scholars program for women and underrepresented minorities to try to provide some of those early hands on experiences. I think we've had fairly good success with, you know, matching some of those students into orthopedic surgery residency and you know sort of get wedding their appetite for orthopedics and then the maintaining it after that. You brought up a really good point that you wish that and dimensions and the Perry initiative existed, you know, more than 20 years ago for those of us like me when women were very minimal in orthopedics but I think the most important when you look at those programs, the end dimensions has a 92% match rate. What is what I see that as being positive is that they have a four year once they get them in, they follow them. So no matter how early on the experiences, if they have no further exposure or no ability to have mentors or guidance, it won't work. So that's why I think you know kudos to programs to your program for having those summer scholars but providing that longitudinal mentoring and guidance is the key. Also, once you have the exposure. So, and I feel like it's, it's a Dr. Canada was saying is like we're going to drop that we have to do in a regular basis like we're locking up that a big percentage of medical students are females right so and then when they're exposed to us as a medical that comes to rotate with us always can encourage them to do it offer them mentorship to kind of like, keep, keep the door open but also be there when they have the interest, and they just, they just have that need that push to kind of continue with what they're looking at and instead of getting discouraged for what they heard. So, I think like engaging in a daily basis in those activities in our institution is a way to to keep more women interested in our field. Thank you. All right, if no one has any more comments about sort of strategies or things they've seen. Then we'll move on to the next article but if you think of any that you want to bring up at the end it's not too late we can always talk about any of these slides later. The next article is the other side of conflict, examining the challenges of female orthopedic surgeons in the workplace. And we have Lisa Canada one of the authors on I'm not sure if any of the other authors were able to make it on tonight. So, we chose this article it's actually, we got the, the initial abstract from a symposium, a meeting symposium abstract. But then Dr Canada sent me the full text article that was just accepted in the American Journal of Surgery that should be coming out now essentially. And so I'll go with you through with you some of the key findings this was a survey conducted through Ruth Jackson orthopedic society as well as the women in orthopedics Facebook group, and they had 373 female orthopedic surgeon respondents. And, you know, and they asked a lot of different questions sort of about different, you know, potential gender disparities in the workplace and how women felt about it if they felt like those things were more likely to be happening to men or women or, you know, and if they were happening at all at their institutions so the first finding was that approximately 80% of the women orthopedic surgeon respondents reported doing more administrative work than their male counterparts. And in the overwhelming majority 87% of the respondents agreed that women were more likely to be sort of saddled with admin work. Now why is that, I don't know I wouldn't. I wouldn't be brave enough to guess but, but that is something that that women are reporting that they're feeling that they're given more work for less pay essentially asked to do a lot of stuff that goes unpaid in the end. The second finding was that 73% of the respondents had been previously described as bossy to assertive pushy demanding or difficult, and 93% of the respondents agreed that women were more likely to be called those things to be called, you know, to bossy to assertive pushy demanding or difficult compared to a man with a similar demeanor. And women on this call may identify with that as well. The third finding was regarding, you know, gaining positions or promotions and 37% of the respondents felt that they had been passed for a position that they felt qualified for, and they overwhelmingly felt that women were more likely to be passed for those positions that they were qualified for over men. 71% of the respondents reported being written up for behavior that their male counterparts would not or had not been written up for and 74% of the respondents felt that women were more likely to be written up for said behaviors than men. For women who had been written up for certain behaviors that you know men also participate in the impact on the women who had been written up were 11% rate of depression 19% rate of anxiety 23% rate of burnout or decreased job satisfaction and 13% rate of sleep disturbances. And for different women, they reported that these symptoms lasted anywhere from a few weeks after the write up to even years after the write up that you know for some women it was pretty traumatic to feel as if they'd been singled out or written up for things that their men, their male counterparts wouldn't be written up for. And then the last finding was that 17% of the respondents would not choose the same career of orthopedic surgery again. So with that, I would definitely ask you guys to speak up and tell me do these results surprise you. Do you personally, you know, identify with any of these items, do you have any stories that you could tell us about, you know, your responses to these different findings or do you disagree with any of the findings. So first, thank you for selecting this article we are very grateful and I do want to introduce we have our dimension scholar, who is the first author or medical student Patricia road art from Brown University, and she is on the call so I hope she speaks up after I speak. She did tons of work and we are very grateful to the American Journal of Surgery for publishing this, it is in their Association for women surgeons article we felt that this has a very broad, you know, very broad reader ship and also gets us not only in orthopedics but outside of the world of orthopedics and surgery. We did this based on a general surgery article which had a very similar survey which we modeled and then added additional questions, which are common in the literature, you know, a couple And that's it because I want to hear everyone else's comments, something that really, you know, the bossy part ambition in women is a dirty four letter word. And I think that seems to be not only for the women for the men, seeing them that way, but also women sometimes do not help or promote other women, we need to bring each other up we need to help each other. We want to shine in each other's lights. And I think that's the impetus for us to all mentor others and try and make the path, better for those that follow. I mean I think I want my legacy to be mentoring and education, mentoring especially to help, you know, make it easier, make it better, and to show that they can accomplish what they want, and to show people they can be orthopedic surgeons. Thank you Dr Canada for that introduction Hello everybody, my name is Patricia. I'm a medical student at Brown and I was very lucky to have been a part of this project with an all women team of researchers to orthopedic surgeons, one orthopedic resident and myself, Yeah, I think being a part of this project was really important to me because I had the chance to really imagine what a candid view of my future could look like if I choose to pursue orthopedics which I think I will because I'm on a research year right now so I hope I don't change my mind. But I think what has been interesting for me was like writing, helping write the paper you know, really learning about this and taking it to heart, and then not even being a residency yet and kind of beginning to experience some of those things. I was lucky enough to have Dr Canada as my main mentor and similar to what Michelle what you were saying having a mentor who's a woman early on, and not even seeing like orthopedics as a barrier just seeing what an awesome. orthopedic surgeon woman can do like I had that view, and then to go from that to some settings where I'm only of course surrounded by male orthopedic surgeons, and even like male medical students, and just seeing how I can't often like relate to what others are right or whenever something's being talked to me and my male counterpart, they will only look at my male counterpart, even though we both done more work or even maybe I've done a little bit more on that specific project. And so, thinking about what orthopedic surgeons have been going through but also seeing what medical students. For me, now seeing that in my eyes as a medical student pursuing the career is sad but then that's why I'm grateful to have conversations like this. And I would hope that more of the men would be a part of these conversations. And not only just at the program director level or faculty level but also like the medical student and resident level, like our counterparts and peers in training who may be benefiting from our lights being dim to an extent. So that's that's kind of off track but all of that to say I'm grateful for this experience and I'd love to continue listening to your discussions further. This is Suzanne I'm one of the residents at the University of Pittsburgh. I actually am really the stat with where it says you know bossy 73% described as bossy assertive pushy demanding etc. Um, that's really interesting to me and I am actually wondering, you know, if we broke that down. Do the women who, you know, filled out this the questionnaire. You know who was kind of describing them as who is labeling them as that. Because I think Dr. Canada what you had mentioned before, you know, sometimes it is females and it may not be females within orthopedics because obviously we will be interacting with other specialties throughout the day, at least at my level as a resident. And so I kind of wonder, you know, is there a little bit of kind of female on female or women on women that could also be more, you know, it could be highlighted and targeted to to make each other aware because I actually have had a personal instance. You know, kind of where I was labeled, you know, one of these things and it was by a female attending but when I described the situation to my male orthopedic attending. I mean I did absolutely nothing wrong and you know there's nothing wrong in situation on my end, but it's really interesting that you know as females were not I think there's room that we could potentially be supporting each other more. And so I'd be interested to see if we're hearing this a lot from our counterparts or the majority from from males. Patricia, do you want to answer that based on the responses that we had by age group and setting. Yeah, so firstly, we did ask some follow up questions, I think, specifically to the being written up and we we did ask who reported you in like the position or the gender of the person who reported. I don't recall the specific numbers or we didn't find any statistical significant results. But yeah, Dr. Kenner, I would love for you to talk about the job setting. You're muted. Yes, I'm trying to be. Sorry, I didn't want you to hear if I sneezed or anything. So in the job setting, you know, the we looked at the differences and this fits in nicely with the other article, you know, covered in a lot of people were hospital employed and private practice. So this is not just limited to academics or to residents in some of the behaviors happen more for women that were older in in practice for 10 years to 20 years or more. So that's what we want to point out. This is universal. It's not limited to a specific setting. And as people get used to seeing more women in orthopedics, perhaps this perception can change. I mean, I think of that little cartoon, which you might have seen. There's cartoons that are that go through the women in orthopedics Facebook page and such that show a woman, a female trauma surgeon and a male trauma surgeon that come in the room, and the perception of both to me that just is what this represents. You know how the nurses were more receptive to the male and they thought he was great and to the female they thought she was not a nice person describing her in that way. So I think we have to overcome that perception that exists. And it's unfortunately from our survey across the board. So we just got to keep on working and we can do it. Awesome. Thank you guys so much for being on the call to discuss your own work and thank you for contributing to literature and giving us this data that we can discuss. With that, we can always loop back or if anybody has any specific questions or any other feedback they want to bring up then we can definitely come back but at this point I kind of want to reintroduce the discussion panel, you know, our special guest here is the Bowdoin family of orthopedic surgeons they're quite a remarkable group for anybody who tuned in late I gave them a short introduction earlier but in summary, Dr. Scott Bowdoin is on the call he's the chairman of the Department of orthopedic surgery at Emory University, and of his five children for his four daughters and of his four daughters, all four of them are now orthopedic surgery residents, which is just so cool and so different. I know when I heard about it I was like really impressed that Dr. Bowdoin had somehow spawned all of these awesome female orthopedic surgeons. So I have their pictures up here and I'll leave them up here for a minute I won't read completely reintroduce them but Lauren, Allison, and Stephanie are PGY-5 residents and Suzanne is a PGY-3 resident. So at this point, if you don't mind I'm going to stop sharing my screen so that we can all kind of see each other and feel free to take, you know, put your camera back on if you so desire. But, Dr. Bowdoin, do you mind sort of just, you know, introducing yourself giving maybe a little bit about your story of how this came to be that you had, you know, four orthopedic surgery resident daughters and how you feel about it. Sure. Thanks, Dr. Coleman. Thanks for inviting me and for us. I'm an orthopedic spine surgeon. I've been in practice at Emory for 30 years and have five kids, four of whom are daughters, and I might have been the last one in the family to find out that they had decided on orthopedics. I knew they had an inkling for for heading to surgery rather than medicine. And for me, you know, it's really kind of fun to watch. I think anytime somebody goes into sort of the family business, if you will, it's always an interesting and fun dynamic. So I'll kind of stop there so we have plenty of time for discussion. Anybody do y'all want to kind of speak up introduce yourselves a little bit further. Maybe talk about your path to orthopedics, maybe in inspiration of or in spite of your father. I'll go first. Hey y'all I'm Lauren. I'm the oldest of the triplets. So I usually have to go first. I'll say I don't know I we played sports a lot growing up. And so I was introduced to orthopedic surgery. Thankfully on the non op side but from injuries as a kid kind of the way that a lot of us get involved. And I knew my dad was a spine surgeon but I often didn't really know what that meant until I started asking questions. Actually as an adult. But I kind of knew that he enjoyed what he did. I also have an aunt who does not spine surgery but hand surgery, and she always loved what she did. And then for my interactions as a patient and kind of knowing what the field entailed, I was just always interested in it. I think I actually decided to last as the three of us. Like most of the way through my third year, and I definitely told my dad last told my mom first. And she's a doctor but she's not an ortho. But I think it was just a combination of the people that you meet and the things that you kind of want to do I knew I wanted to use my hands I knew I like different types of things. Kind of like a lot of the similar stories I think we all have by the time we get this far in our careers. But I will say my dad used to try to push us to do things when we were really little, and I think the last time he did that was for college. He wanted us to go to the college he went to and none of us even applied. So I think he got the message and backed off and I think that's been very helpful in our careers. I can go next. Hey guys, I'm Stephanie. I was born second, so we'll keep it in birth order. I'm a fifth year at Pitt. But yeah, similar to what Lauren said, I think we all kind of had an inkling growing up that we were all active. We liked being in the action, but we were never really pushed into medicine. And so that was kind of helpful that we kind of came to it on our own. I think just growing up in a family that was medical and seeing that they were kind of fulfilled with their careers and still had a family life was important. And then for me, specifically in college, I was starting to think about medicine and sports medicine because I had my own shoulder surgery from a sports injury. And so kind of got introduced on the patient side and started talking to my dad. And he encouraged me to look for opportunities to kind of shadow and get exposure early, which I think Dr. Coleman, Dr. Canada both kind of touched on how important it is for early exposure. And so in college, I found a women in sports medicine internship program actually that I did over a summer where I went up to hospital for special surgery and got to work with kind of an amazing group of all female orthopedic sports surgeons. And that was huge for me to just kind of see role models that looked like me and that were happy in their careers and kind of had families as well. And so seeing all that really kind of lit a fire in me and then went to medical school and used every opportunity I could to make connections and find mentors. And I think what Dr. Canada had said about finding mentors that are kind of more lifelong and lasting and aren't just there for a season is key. And so they've kind of influenced me throughout my entire career so far. And so that's kind of how I ended up where I am and very thankful for all the support that I've had, both from my family and from other people as well. Hi everyone, I'm Allison. I guess you now know that I'm the youngest of the triplets. So I think kind of echoing what they said, my kind of friend orthopedic started, I think when I was in college, I had some early exposure with a shadowing opportunity at Grady. Spent the summer with Stephanie actually, shadowing some trauma surgeons and kind of fell in love with orthopedics at that point in time. Went into medical school thinking that I would do orthopedics, but given that Lauren and Stephanie were interested in it as well, I tried everything that I could to find something else to fall in love with. And fortunately I ended up falling in love with orthopedics. That's kind of how I got into it. All right, I'm Suzanne, third year at Pittsburgh. I like to think that I was the rebel of the family, but clearly that didn't get me very far. So my story is a little bit different. I obviously, I'm two years younger than my triplet sisters. So I'm kind of, you know, we have both of our parents are doctors or dad's spine surgeon. And now I've got, you know, three sisters who are kind of pursuing, you know, medicine and potentially ortho. So I was not like, you know, gung-ho about ortho or medicine. It actually took me a little bit while to kind of realize that's actually what I wanted to do. And it kind of came about where it was basically like, well, you know, shadow and just, you know, get the experience so you know what you're actually dealing with to make that informed decision. And it was actually through those experiences where I was like, damn it. Like this, this is kind of cool. This is something I actually can see myself doing. So that's how I kind of made my way into medicine or medical school. And then even within medical school, I was like, well, I don't want to, I need to do something different. You know, I got the rest of the family's going into ortho, you know, anything else that I could like basically do. But once I actually was in the OR and doing, I realized, you know, as you're told as a medical student, it's like, okay, you know, surgery versus no surgery, it's got to be your first decision. And so very clearly I was like surgery, like Lauren was saying, you know, I just want to work with my hands. That's how I want to like help fix people problems. And then once I got into like, you know, shadowing more with, you know, people within orthopedics, it just kind of clicked and made sense. And I think, you know, deep down, I'd been holding back for so long, but it definitely was the right decision for me. And so it was kind of a little roundabout way, but that's how I ended up where I'm at. Thank you guys for sharing your stories. It's so unique and so cool to hear how all of you kind of reluctantly fell in line with dad eventually. So Dr. Bowden, knowing, you know, you've been around for a while, I think you said earlier something like your PGY, you know, 37 or something like that. Knowing that orthopedics is a male dominated field and knowing that bias exists and knowing that, you know, they might be exposed to microaggressions or even real aggressions throughout their training, you know, what were your thoughts and how did you advise them? What were your concerns? And, you know, how did you kind of navigate that side of things, the realities? You know, so it's interesting, when I went into orthopedics, it was still had the stereotype of being big, strong guys. And so actually I didn't feel like I belonged in orthopedics, interestingly enough. Not for gender reasons, but I didn't feel like I fit the mold. And, you know, I had run into a couple of role models as orthopedic surgeons that also didn't fit that mold and, you know, were more like me and a little bit more interested in sort of intellectual curiosity and some research questions. So even as a male, I was not the prototypical orthopod. Having said that, you know, and having been at Emory for a long time, as I started to take more of a close interest in our residency program, it was clear to me that it was feeling more and more like a fraternity house. And, you know, that wasn't an environment that I thought was appropriate for, you know, the times. 30 years ago, it kind of was a fraternity house. And back then that was accepted, but it's not the case anymore. And so it really took a cultural change of the environment. And, you know, quite frankly, having, you know, the way I approached it is, if my daughters ever went into medicine and if they ever became orthopedic surgeons, what would I want the environment that they work in to be like? And so, you know, my advice, one of the questions you had on the sheet was what advice would you give to men? And my advice would be to have four daughters that become orthopedic surgeons, and that'll take care of your approach to, you know, the environment. Any other more practical advice? You know, I think it would be repetitive. I think that, you know, the more we have, you know, more diversity in orthopedics, not just, you know, gender, but other diversity, the more people will not feel like it's not for them. And then I think, you know, a lot of the other stuff will fix itself. When you have a diverse environment, you know, it's hard to continue that fraternity mentality. And so I think, you know, mentoring's important, advocacy, sponsorship, all those things. But, you know, I sponsor women, but I also sponsor men. I mean, I sponsor qualified individuals who I think it's the right, you know, time in their career and who seem to want, you know, advice and sponsorship. So I don't discriminate that. And I think the, you know, the biggest difference is to basically, you know, increase the pipeline and make sure that all of us, you know, actively try and make the environments that we work in a better place and to not just tolerate or accept things. And I think we're all accountable for the environment that we work in. For the residents, have you experienced microaggressions and how did you, you know, deal with that? Was it in medical school? You know, was it in residency? Have you, do you have anything to share about how you've dealt with that? Maybe it's been different for you having a little bit more of a community amongst each other to kind of work through that. Yeah, I can tackle this one. I think all of us, like you said, we're in a unique experience in that all of us are residents at the same time. And so there is something to be said for that because we are very much supportive of each other and we have a group chat within ourselves and talk about this stuff kind of all the time, which I think a lot of people don't necessarily have. But I think everyone, whether they know it or not, experiences microaggressions. Being a female and especially a female that appears to be a little bit more especially a female that appears younger in age, I think on almost a daily basis, my status is questioned mainly by patients. And sometimes I do have attendings who will stand up for me and say something if a patient refers to me as a nurse or questions why I'm there, which is great to see people kind of recognizing that that's happening and starting to create a dialogue and say something and not just brush it off. One of the more, I guess, poignant microaggressions that happens to me actually pretty recently. So I'm the chief currently on my trauma service. And so you're routinely kind of doing skin-to-skin cases with attending supervision. And so when I'm in the operating room, one of the scrub techs who's a male will pretty much question everything I do. So if I say, for instance, ask for the knife, he'll say, oh, like you're doing this. Or if I ask for a specific instrument, he'll say, oh, are you sure? And just kind of little jabs like that, which I don't even know if they recognize that they do it or that other people kind of perceive it. But there's obviously other people in the room and to be questioned at every step of the case is a microaggression. And so I think it's kind of difficult situation as a resident to go through because you don't exactly want to say something right in the moment and make people uncomfortable. But at the same time, if you let it keep happening, then you're also kind of part of the problem. And so I don't know that I have a great answer as far as what to do about it. And I can be frankly honest and say, I've kind of brushed it under the rug and ignored it, but I think it is a common experience. And I know I'm probably not alone with that, so. You're definitely not alone. Anyone else want to speak up on that topic? Or give any examples? I don't really have any, well, I can't really think of any specific examples, let's say, but agreed. I mean, I think the most common is just kind of patience, not really being able to say, patience, not really perceiving you as a resident, but I don't have any specific stories that I can think of right now. And what advice would you give to medical students who are on this webinar now, who are interested in orthopedic surgery? I think the advice that I would give is orthopedics is awesome. And I think we are all having these conversations more and more and we can be part of the change. And so I just encourage people to stick with what they want to do. Don't let other people discourage you. There's plenty of people out here, probably everyone in this webinar that you can reach out to if you want a mentor, need someone to talk to, but I think it's important to have someone or need someone to talk to. But I think that orthopedics is a fantastic specialty. There's just so much you can do with it. It's very gratifying. I wouldn't go back and change it, my career choice at this point, at least. And just meet more and more people. I think take advantage of all the opportunities that you can because it's a small world and we're a part of that small world. And so the more we can connect and kind of reach out, I think the better. Yeah, I agree. I think if you're interested at all in orthopedics, I think getting early exposure through these fantastic programs like the Cary Initiative, which is something that I did as a medical student and something that I now volunteer and help out at as a resident, is a great way to gain exposure and meet local residents, practicing physicians, who you can now kind of begin to have a network of people that you can reach out to and ask questions for. I 100% will give everyone my cell phone number, email, whatever, anyone can reach out to me at any point in time. And if you're interested, find people in the field and don't be shy. So we do have a question in the chat. I can go ahead and read out for everyone. Do you recommend applying to programs that historically have not taken any females? I can take a stab at that one. Certainly for programs that don't have any women, somebody is gonna be the first. And I would say that there's probably a greater risk of the culture not being ready or accepting of that kind of diversity, but not necessarily. At Emory, we had trained women sporadically and had out of 30 residents, one or two residents, maybe three total. And we got to a point several years ago where we were going to be down to zero. And we as a group made the conscious decision that that was not okay. And that for an environment that was gonna be comfortable for women to train in, we needed more than just one. And so we actually matched three women that year and have averaged out of six spots. So we're now a much higher percentage and nobody's gonna be talked about as that woman orthopedic resident. We wanted to make sure that nobody could be described that way in our program. But in any program, somebody is gonna be the first. From a resident perspective, I think it's important to try to break that bond that's there. Someone's gotta eventually be the first one. So I mean, I think it would be important to apply and because in the end, I mean, you're making way for future applicants to be like, hey, there is a female or a woman at that program or this person does look like me. So someone's gotta do it. So why not be you? Thank you. I think for me, going through the application process, you have to weigh a couple of different things. One of them is, are there female faculty? Because having a tribe, whether it's other residents or it's female faculty, I think can really make the experience better and make you feel more supported. So if you have female faculty who seem engaged and that they will mentor you and kind of have a community with you when you arrive, I think that's a big plus. And it would be a little bit less risky to be the first female resident if there were already female faculty established there. So that's one thing that might sway me. But, and another thing that would sway me is just the environment that you pick up with when you're doing your interviews, which is harder on a Zoom interview situation. But if you're going in person and you feel like the men who are interviewing you are genuinely interested in you and you could picture them being mentors for you in the future, then your gut is probably correct, that it probably is an environment where you can flourish and have connections and have great male mentors. But if you go and you kind of feel like the only woman while you're there interviewing, then you're probably gonna feel kind of like alone when you get there. So I think those are two things to think of, but I don't think it's an absolute no. I think they're, like Dr. Bowdoin was saying, there are a lot of programs who are very receptive for women, want women, are dying to match women, rank women highly every year and don't match any women just because they don't have any to start with. So it's not a definite no, but there are some inherent risks for sure. And I personally, of at least one woman who was the first female at a program and was extremely unhappy and just had a terrible, terrible experience, because that was a program that wasn't ready, the leadership of the program was ready for women, but the faculty weren't ready. So you kind of have to get a feel that it's not just the chairman pushing, or it's not just the program director pushing for women, that it's actually the whole community there that is open. Any other general questions from the panel or any other sort of late comments or thoughts about the articles? Completely open-ended questions at this point. Yeah, hey, this is Sandy Klein again. Just, I had one more comment. I think in general, we as women surgeons, we're never gonna escape microaggressions. I love the example about the scrub tech. I've been in the same situation even as an attending. And that all is gonna be out there. Our nurses are going to challenge us. We saw the study where women get reported at higher rates than men for the same sort of things. And so what it really comes down to is the leadership in our department and the culture within our own departments and people who are willing to stand up for us. And even beyond that, people who are willing to believe us. When you walk into somebody's office and you say, yeah, this is happening to me. I think it's because I'm a woman and I'm being treated this way. I think we all have to be surrounded by people who will say, tell me more about that. Help me understand. I wanna see your perspective. And they may not be able to do anything to change what's going on around us because we can't change the world and we can't change the society that we live in. But we do need leaders and partners, especially our male leaders and partners to believe us and do their best to hear our perspective. They can't walk on our shoes if you're not a woman. I don't think you can really understand exactly what it's like. But I think that effort can be made to support us just by hearing our stories and trying to be there and help in any way they can. Thank you for having this webinar and hopefully it will encourage the start of good discussions to improve the future of orthopedics. Thank you so much for coming. Thanks to everyone for coming and for participating in the conversation. We really appreciate you. And if you would like to claim CME credit, the link is in the chat for you to claim that. And with that, we'll end a little early. Thank you so much. Have a great night.

Advocacy for Women in Orthopedics

ALFAS

ARCHALS

Ruth Jackson Orthopedic Society

challenges faced by women in orthopedics

gender disparities in academic positions

sexual harassment

early exposure and mentorship

diversity and inclusion in orthopedic surgery

Bowdoin family of orthopedic surgeons

mentorship and support