Navigating Surgical Residency as a Trainee – and a Woman

For the first time, Cleveland Clinic will offer a professional development program geared for women general surgery residents. The day-and-a-half event, to be held Sept. 13 – 14, 2019, is the brainchild of Ajita Prabhu, MD, a staff surgeon in the Digestive Disease & Surgery Institute and assistant professor of surgery at Cleveland Clinic Lerner College of Medicine.

“The program focuses on professional development, acknowledging that skills such as public speaking, networking, time management and the cultivation of leadership traits are learned and practiced,” says Dr. Prabhu. “Most of us aren’t born with these skills. We will give tips to help residents become very skilled professionals.”

The program, Enhancing the General Surgery Resident Experience, goes beyond standard professional development training, however. It offers a unique perspective for women surgical residents, emphasizing challenges that disproportionately affect women trainees and providing strategies for overcoming those challenges.

“This course is not an angry rant about sexism,” stresses Dr. Prabhu. “It acknowledges the unconscious biases in the world we live in and offers insight for skillfully navigating that world.”

Seven challenges facing women residents

Dr. Prabhu cites seven issues facing women surgery residents, many of which will be addressed at the September event:

1. Autonomy in the operating room – All surgical residents are given graduated autonomy in the OR. “It usually begins with allowing trainees to do some small part of a case, or one move. They get feedback and move on to the next thing,” says Dr. Prabhu. “As they progress through their residencies, there should be an associated increase in the amount of autonomy.” But a 2017 multi-center study of the degree of autonomy that faculty gave thoracic surgery trainees found a significant bias against female residents.
2. Mistaken for a nurse or other healthcare personnel – “This gets to the heart of unconscious bias,” says Dr. Prabhu. “It’s often benign, but both patients and hospital workers frequently harbor the misconception that women physicians are nurses.”
3. The double bind phenomenon – “A woman professional can either be viewed as competent or likable, but rarely both,” says Dr. Prabhu. “It’s difficult for some people to swallow the idea that if you’re a nice person, you can also be very good at your job as a woman.”
4. Work without reward – “There is a tendency for women in all fields to take on work without reward – work that will never be a line on your curriculum vitae, advance you professionally or make a meaningful change at work,” says Dr. Prabhu. That may include being asked to serve on an arcane committee or fill a perfunctory role.
5. Microaggressions – “These are subtle comments or actions directed toward anything that makes you be viewed as different,” says Dr. Prabhu. “They can be based on gender, race, religious beliefs, sexual orientation and so on.” For instance, a women might be told she wasn’t selected for a leadership position because the team thought she would want more time at home with her family, or attendees at a conference comment on a female presenter’s hairstyle or clothing rather than the content of her presentation.
6. The expectation for socialization – Women physicians are expected to chit-chat with co-workers, particularly other women. “There is more socialization required around a work request than should be normal,” says Dr. Prabhu. For example, the physician is expected to make small talk with nurses on a surgical floor prior to asking them to remove a patient’s nasogastric tube. If female physicians are direct and simply ask nurses to remove the NG tube, they may be viewed as uppity.
7. Representation at leadership levels – “If you look at the broad population of practicing physicians, many hospital systems don’t have women represented at the same rates in leadership positions as they are in the workplace,” says Dr. Prabhu.

Conversation and commitment can change the landscape

Despite these historical challenges, Dr. Prabhu is hopeful that the tide is turning. “There is a lot of commitment in many hospital systems to inclusion and diversity, and there are a growing number of educational initiatives around the issue,” she says.

Cleveland Clinic’s upcoming program is one example. “The conversations we are going to have at the course are meaningful and relevant – for both men and women,” says Dr. Prabhu. Sessions by leading surgeons across the nation will cover topics ranging from selecting a surgical specialty and finding a mentor to interacting with other women at work and balancing work/life obligations.

“The goal is to acknowledge that while challenges exist for women surgery residents, they can prepare for them and grow their skill set to navigate those challenges,” says Dr. Prabhu. “If they can do that, they will be successful despite the challenges.”