Host:
Mohit Bhandari, MD, PhD, FRCSC
Editor-in-Chief, OrthoEvidence
Guest:
Laurie A Hiemstra, MD, PhD, FRCSC
Orthopaedic Surgeon/Director of Research at Banff Sport Medicine Foundation
Associate Professor at University of Calgary
PERSPECTIVES
Drs. Hiemstra and Bhandari discussed gender diversity in orthopaedic surgery practice and specialty. Our discussion uncovered 4 core themes. These themes and their supporting insights are highlighted below.
1. Increasing Attention On Gender Diversity In Orthopaedics
Dr. Hiemstra has been actively working on advocacy efforts towards improving gender diversity in orthopaedics. Dr. Hiemstra holds the position of associate professor at the University of Calgary, heads the Canadian Orthopedic Association (COA)’s gender diversity program, acts as one of the founding members of the International Orthopedic Diversity Alliance (IODA), chairs the International Society of Arthroscopy, Knee Surgery and Orthopaedic Sports Medicine (ISAKOS) Gender Diversity Task Force and is the second president-elect of the COA. Dr. Hiemstra regards that there has been more and more focus and progress on gender diversity globally. In medicine, much still remains to be done.
Around the world, gender diversity has come out in a huge way in the last few years” “[…] I think about medicine, the whole gender diversity issue was still really just getting its feet wet […] When I started looking into it, layer upon layer of social cultural issues are rounding diversity and gender diversity, which of course extends to racial diversity and all the other ones also. I think the number of committees out there just shows you how far we’ve come. — Dr. Hiemstra
Current gender statistics show an imbalance between men and women in orthopaedics. Among the COA members which reflect current characteristics of orthopaedic surgeons in Canada, only about 12% are women. In terms of role models in leadership positions, a study shows that in Canada merely 1% of clinical professors are women, and in Dr. Hiemstra’s view, this mirrors everywhere else in the world where looking higher in leadership roles means less women.
2. Diversity and Inclusion
Drs. Hiemstra and Bhandari regard that it is not enough to just have appropriate numbers of women in a faculty or committee; they believe the key to achieving true diversity and inclusion is to ensure that everyone’s point of view is heard.
The issue of diversity versus inclusion is important. One thing would be to say we have a certain percentage of men and women being part of the faculty. The other thing is what the experiences of women in orthopedics is. It gets to the point of ‘Do you feel heard? Do you feel included?’ Inclusion is progress we’re making beyond diversity […] If you just have a homogeneous group, they’re unlikely to make decisions that would be superior to those in which you have gender diversity, and you can add ethnic or geographic diversity, and different ages, bringing in different levels of experience […] Ultimately, the meaning comes in the fact that everyone feels their voices are heard and included. — Dr. Bhandari
3. Barriers and Challenges
Dr. Bhandari believes that there has been an awareness of the importance of gender diversity as well as advocacy among surgical subspecialties, for example, the more diverse workspace is in orthopaedic departments. Heads of department would love to be more diverse. In Dr. Hiemstra’s view, the fundamental barriers and challenges are deep rooted in history. Also, one of the biggest barriers is the “hidden” curriculum surrounding women through every part of their medical career, where a mentor provides suggestions based on traditional role expectation in culture.
Most of the barriers are deep rooted in our culture and deep rooted in medicine right from hundreds of years ago. So it’s not like you can make a new rule and it’s going to change […] A lot of that has to do with what they call the ‘hidden’ curriculum. To women in medicine, their mentors (would say), ‘It’s hard to take care of your family if you have (to take on a) surgery […]’ The culture that women take care of the family and that men work has been deep rooted for thousands of years and is mixed right into our medical curriculum. — Dr. Hiemstra
4. Strategies to Improve Diversity and Inclusion
Dr. Hiemstra regards it as important to get women more interested in surgical subspecialties and to start to do it early, and to have strong mentorship that can counteract the ‘hidden’ curriculum and ultimately change the culture. The advocacy that Dr. Hiemstra has been doing in the COA includes the establishment and dissemination of diversity and inclusion statements, as well as ensuring gender diversity among speakers at meetings. At recent COA events, special sessions of talks and open discussion were arranged for residents, medical students, and high school students to have the interaction with women specialists. The meeting attendants could hear about the experiences from the speakers who have lived through the challenges.
From an international scope, Estonia ranks first, with the highest proportion of women practicing in orthopaedics. Over 26% of the orthopaedic surgeons are women in Estonia (Green et al. Journal of Trauma & Orthopaedics, Vol08, Issue 01, pp. 44-51), as they have some very progressive ways of encouraging women in medicine and in orthopedics. Dr. Hiemstra regards it as highly valuable to learn from counties with success stories like that and how they have managed to change the culture around their medical practices.
I think ultimately we need to change culture […] We need to build it (diversity and inclusion) into our culture, and we need to make it the norm. My ultimate dream is that what I’ve been doing with the COA is not needed anymore. All that inclusion, all the diversity is actually so part of our culture that is its second nature. But that only comes if it’s part of our culture in Canada also. — Dr. Hiemstra
Questions and Answers:
Dr. Bhandari: How important is it to have men also advocating gender diversity?
Dr. Hiemstra: It is vital to have men really join in this movement because men have been in charge of medicine and surgery for many years in Canada and hold the power. Power needs to be shared and that realization needs to come that men and women are equal, and should all have the same opportunity. The twitter “#HeForShe” is one of the good advocacies.
Dr. Bhandari: What is the expectation in the proportion of women in orthopaedics for the future? Would it be 50% or more than that?
Dr. Hiemstra: Not necessarily to be 50/50. Orthopedics is a fairly “hands-on” specialty. Men and women complement each other. If there is true equity of opportunity for women to get into orthopedics should they desire so, we would then actually find out what an appropriate number is
SENSE-MAKING
Drs. Hiemstra and Bhandari discussed gender diversity and inclusion in orthopaedics. The proportion of women practicing orthopaedic surgery has been low. To improve the diversity and inclusion of women, it is important to disintegrate the cultural norms and ‘hidden’ curriculum that may steer women away from an orthopedic subspecialty, encourage female mentorship in the field, ensure everyone’s point of view is heard, and have men’s involvement in the movement.
How to Cite:
Laurie A Hiemstra. (2020, September). Towards Gender Diversity in Surgery. Available from:
