Overcoming the Impact of COVID-19 on Surgical Mentorship: A Scoping Review of Long-distance Mentorship in Surgery.

Violence and discrimination are common events at work, especially in health care. Moreover, such workplace experiences are considered to have negative impacts and particularly adverse health consequences on health care workers. Nevertheless, the problem is still highly underreported and thus largely ignored and unexplored in Switzerland as comprehensive data and studies on their prevalence and health correlates among hospital staffs and health professionals are widely missing.This cross-sectional study was based on secondary data from a company survey among several public hospitals and rehabilitation clinics in German-speaking Switzerland conducted in 2015/16. The study population was limited to a subsample of 1567 health professionals among the surveyed staffs of five participating hospitals and clinics. Relative frequencies of different forms of violence and discrimination at work and the total number of such experiences were calculated for the entire study population and for occupational subgroups. These data were compared with a nationally representative subsample of the Swiss Health Survey 2017 as a reference population. Multiple logistic regression analyses were further computed to investigate the association between the number of different experienced forms of violence and/or discrimination at work and several poor general and mental health outcomes.23% of the inverviewed hospital employees experienced at least one form of discrimination or violence at work in the past year, compared to 18% of the general working population. Nurses were by far the most affected occupational group regarding all forms of violence. More and particularly the most exposed and affected hospital employees with regard to experiences of violence and/or discrimination at work showed almost consistently increased frequencies and relative risks for the studied poor mental and general health outcomes. Prevalence rates and odds ratios for strong sleep disorders, strong stress feelings and increased burnout symptoms were between 3 and 4 times higher among the most exposed compared to the non-exposed group of hospital employees.Study findings underline the importance of an active combat against violent and discriminatory behaviors in health care. Prevention strategies should particularly focus on nurses and midwives, which turned out to be the most affected and exposed group of all health professions. 

/pdf/prevalence-and-health-correlates-of-workplace-violence-and-psw300ii.pdf

Prevalence and health correlates of workplace violence and discrimination against hospital employees – a cross-sectional study in German-speaking Switzerland

Despite the increasing numbers of female medical students, surgery remains male-dominated.To highlight the principal career obstacles experienced by aspiring female surgeons.A narrative review of literature on the position and career barriers of female surgeons has been conducted, using the MEDLINE and EMBASE databases.Implicit and even explicit biases against female surgeons remain prevalent, negatively impacting their training performance and overall professional trajectory. Female surgeons are globally underrepresented in leadership positions and senior academic rankings, especially that of a full professor. They feel hampered by lack of effective mentorship, whose value for a successful career has been acknowledged by all medical students, surgeons and surgical leaders. Their work-life imbalance is sometimes expressed as lower likelihood than their male contemporaries of getting married or having children and may be attributed to their conventional association with the role of caretaker, their personal desire to accommodate occupational and family duties and the inadequate implementation of parental leave and childcare policies. Female surgeons' "infertility" may be further explained by direct and indirect pregnancy-related difficulties. Female surgeons are also financially undercompensated compared to their male contemporaries. Finally, specialty-specific challenges should not be overlooked.While encouraging steps have been made, women in surgery feel still hindered by various obstacles. The qualitative, interview-based nature of current literature requires more meticulous studies on these barriers with a more quantitative and objective approach. Attenuation of gender imbalance in surgical specialties requires further changes in mentality and more targeted modifications in relevant policies. 

Career barriers for women in surgery.

Diversity is broadly defined as the inclusion of varied attributes or characteristics. In the medical community, diversity often refers to the inclusion of healthcare professionals, trainees, educators, researchers, and patients of varied race, ethnicity, gender, disability, social class, socioeconomic status, sexual orientation, gender identity, primary spoken language, and geographic region.Discrimination in the healthcare setting can be defined as negative actions or lack of consideration given to an individual or group that occurs because of a preconceived and unjustified opinion. It is worth noting that individuals do not need to be members of an unfairly treated group to experience discrimination against that group. Discrimination can occur based upon perceived membership. Furthermore, harm does not need to occur for discrimination to exist. A group may be discriminated against if they receive something of less value than another group solely because of their race, ethnicity, gender, disability, social class, socioeconomic status, sexual orientation, gender identity, primary spoken language, or location of residence.While people can be discriminated against for various reasons, this article focuses mainly on gender, ethnicity, and race-based discrimination in the healthcare setting, not because these are the most important, but because these areas are best represented in the literature. We hope that the next version of this article will include more information on discrimination involving other underrepresented and marginalized groups.

Diversity and Discrimination In Healthcare

OBJECTIVE A meta-analysis was performed to understand disparities in the representation of female authorship within the neurosurgical literature and implications for career advancement of women in neurosurgery. METHODS Author names for articles published in 16 of the top neurosurgical journals from 2002 to 2019 were obtained from MEDLINE. The gender of each author was determined using automated prediction methods. Publication trends were compared over time and across subdisciplines. Female authorship was also compared to the proportionate composition of women in the field over time. RESULTS The metadata obtained from 16 major neurosurgical journals yielded 66,546 research articles. Gender was successfully determined for 96% (127,809/133,578) of first and senior authors, while the remainder (3.9%) were unable to be determined through prediction methods. Across all years, 13.3% (8826) of articles had female first authorship and 9.1% (6073) had female senior authorship. Female first authorship increased significantly over time from 5.8% in 2002 to 17.2% in 2019 (p < 0.001). Female senior authorship also increased significantly over time, from 5.5% in 2002 to 12.0% in 2019 (p < 0.001). The journals with the highest proportions of female first authors and senior authors were the Journal of Neurosurgery: Pediatrics (33.5%) and the Asian Journal of Neurosurgery (23.8%), respectively. Operative Neurosurgery had the lowest fraction of female first (12.4%) and senior (4.7%) authors. There was a significant difference between the year-by-year proportion of female neurosurgical trainees and the year-by-year proportion of female neurosurgical first (p < 0.001) and senior (p < 0.001) authors. Articles were also more likely to have a female first author if the senior author of the article was female (OR 2.69, CI 2.52-2.86; p < 0.001). From 1944 to 2019, the Journal of Neurosurgery showed a steady increase in female first and senior authorship, with a plateau beginning in the 1990s. CONCLUSIONS Large meta-analysis techniques have the potential to effectively leverage large amounts of bibliometric data to quantify the representation of female authorship in the neurosurgical literature. The proportion of female authors in major neurosurgical journals has steadily increased. However, the rate of increase in female senior authorship has lagged behind the rate of increase in first authorship, indicating a disparity in academic advancement in women in neurosurgery.

Increases in female academic productivity and female mentorship highlight sustained progress in previously identified neurosurgical gender disparities.

Has a critical mass of women resulted in gender equity in gynecologic surgery

Background The availability and utility of public statements and policies on gender equity from professional surgical societies has not been studied. Methods Professional surgical society websites were searched for publicly available statements and policies related to gender equity. These were compiled and assessed for critical components. Results Publicly available statements/policies were published in every surgical society, though few pertained specifically to gender. Nearly all were recently written or revised. The most common statement/policy addressed discrimination and harassment. The only policies/statements that reliably contained all four key components pertained to professional conduct at national meetings. All policies that provided consequences also contained specific reporting processes. Conclusions Gender equity statements and policies are deficient among professional surgical societies. Prioritization of publicizing statements/policies that describe the challenges and provide potential solutions to well-documented gender inequities within surgical fields allows professional societies to promote a diverse and equitable workforce.

Leading from Behind: Paucity of gender equity statements and policies among professional surgical societies

The Time Is Always Right to Do What Is Right for Our Patients.

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Surgical Palliative Care-Who, When, and Why?

Surgical innovation relies on inspiration, initiative, and collaborations based upon shared passions and available resources. Like many other interventions that have improved the care of surgical patients, surgical palliative care has a rich history which has benefitted from the creativity, drive, and dedication of many individuals. Herein lies a brief overview of this surgical subspecialty’s evolution. The term palliative care was coined by Dr. Balfour Mount, a Canadian urologic oncologist. He has been described as the “compassionate vanguard of palliative care” and is considered the Father of Palliative Care in North America. In the early 1970s, after attending a lecture by Dr. Elisabeth Kübler—Ross, Dr. Mount began to recognize that many physicians lacked the ability to adequately address the suffering— experienced by patients and their families—that often accompanies the dying process. He therefore sought additional education by studying with Dame Cicely Saunders, founder of the modern hospice movement, at St. Christopher’s Hospice in London. Following that sentinel visit, Dr. Mount recognized the importance of distinguishing the care offered to patients who were suffering without terminal conditions from the care offered by hospice. Based on the etymology of palliative care “to improve the quality of” (life), palliative care became known as a new discipline of study that aimed to mitigate suffering and improve and preserve quality of life—in all aspects and phases of life, including at the end of life. Dr. Mount became the founding director of the Royal Victoria Hospital Palliative Care Service and McGill University’s integrated Whole Person Care Program. More details of these events can be found in Dr Mount’s memoir Ten Thousand Crossroads: The Path as I Remember, which was published in 2021. Surgical palliative care (SPC) came into vogue in the 1990s, spearheaded by the efforts and passion of Dr. Geoffrey P. Dunn and Dr. Robert Milch and supported by the American College of Surgeons (ACS). Dr. Dunn, a fourth-generation general surgeon, defined SPC as the treatment of suffering and the promotion of quality of life for patients who are seriously or terminally ill under surgical care. In his 2004 book, Surgical Palliative Care, Dr. Dunn reassures the reader that the integration of palliative care into the management of the surgical patient is neither a paradox nor a cultural conflict, and he reminds us that the application of surgical procedures to palliate symptoms dates back to antiquity. What was more central to this perceived paradox was the difficulty of reconciling the surgeon’s ethos to “do everything possible” (operatively, for patients’ bodies) with the need to display empathy, maintain introspection, and work collaboratively within an interdisciplinary team to address a patient’s social, psychological, and spiritual well-being. Dr. Robert Milch, a close friend and collaborator of Dr. Dunn’s, emphasized what he called “the soft underbelly of palliative care, the subjects that surgeons are not always

Founding the Surgical Palliative Care Society

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