Challenges for the Female Surgeon in Orthopedic Surgery - A Scoping Review.

Background: The number of female doctors graduating from medical schools worldwide is increasing; however, orthopedic surgery remains one of the least gender-diverse surgical fields.

Objective: This scoping review aims to map the literature on the challenges faced by female orthopedic surgeons, categorize them into key domains, and identify essential gaps to guide future research and institutional reform.

Methods: A scoping review study design was employed, utilizing the Arksey and O'Malley framework. PubMed, Scopus, and Web of Science were searched for articles published between January 2000 and 2024. Papers that addressed challenges faced by female orthopedic residents and surgeons were included; of the studies screened, 92 met the inclusion criteria.

Results: Challenges were discussed in three main domains: female representation, the health and occupational risks, and the emotional environment. Approximately 23 challenges were identified. While the increase in female representation in orthopedic surgery more than doubled between 2000 and 2020, gender disparity persists. Musculoskeletal injuries were identified as the most common occupational health concern. Microaggressions were described in several forms: verbal comments, assumptions about skills, traditional role stereotypes, sexist language, and exclusion from informal networks.

Limitations: The study's limitations include unexplored multiple challenges due to the limited availability of data, such as unequal pay, patient preferences, and military orthopedic care. Most of the included studies were cross-sectional surveys, which limits generalizability and causal inference.

Conclusion: This review highlights the persistent gender-related challenges in the field of orthopedic surgery. Initiatives for mentorship and representation are in place and appear promising. Nonetheless, challenges related to occupational safety, well-being support, and leadership roles remain inadequately addressed. Future efforts must prioritize mentorship, ergonomic equipment design, strategies to address microaggressions, and institutional commitment to support female orthopedic surgeons.