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CORR Insights®: Residency Selection Preferences and Orthopaedic Career Perceptions: A Notable Mismatch.

Fifty years ago, fewer than one in 100 orthopaedic surgery residents were women [1]. Although diversity in orthopaedic surgery has increased in many ways, including a doubling in the percentage of women residents and faculty members between 1995 and 2011, the changes have lagged behind those observed in medicine in general, or even in other surgical specialties [2]. Calls for change have been sounded by influential leaders in the field [7, 8], but continued progress in this area must come with a full understanding of the barriers to change [5, 11]. The perspectives of medical students, whether they are considering orthopaedic surgery as a career or not, are valuable to help understand differences in the mindsets of men and women and to help gauge how we are doing at portraying the field to potential applicants. In this issue of Clinical Orthopaedics and Related Research, Whitaker et al. [15] surveyed all medical students at one institution and found that women were more likely thanmen to believe that orthopaedics is dominated by men and that it requires physical strength. However, those who have decided to pursue orthopaedic surgery likely have a different perspective about the field than the general medical student population, and another study showed that women applying to orthopaedics felt that women were emotionally, mentally, and physically strong enough to be orthopaedic surgeons [4]. Interestingly, women were more likely than men to agree with these statements, which highlights important areas of bias that still exist among those entering the field. The presence of bias has been mentioned as an area of concern [7], and men and women likely experience it to different extents. Among orthopaedic surgery residency applicants, 68% of women were likely to eliminate a program from their rank list if they felt that a gender bias was present, while less than 1% of men felt that way [4]. In the survey by Whitaker et al. [15], women were also more likely than men to rank role models of the same gender as being important. The significance of same-gender mentorship for women pursuing orthopaedics has been confirmed by another study [4]. This is a difficult hurdle to overcome, because the percentage of residents and faculty in orthopaedic surgery who are women remains low [5], and the percentage of women is increasing more slowly in orthopaedics than in nearly every other surgical specialty [6, 10]. This highlights the importance of continuing to encourage women to pursue orthopaedics and to actively involve women residents and faculty in their mentorship.