Master of Surgical Education thesis research published in The Lancet

As part of her research contributing to a Master of Surgical Education, Dr Rhea Liang and her supervisors published their research in The Lancet.

As part of her research contributing to a Master of Surgical Education Dr Rhea Liang undertook a qualitative study into the reasons why women leave surgical training. Dr Liang works as a breast surgeon at the Gold Coast Hospital and with her supervisors, Professor Tim Dornan from Queen’s University Belfast, and Professor Debra Nestel, Department of Surgery, University of Melbourne (Course Director) published their research in The Lancet.

The research invited women to describe in-depth why they had chosen to leave surgical training soon after they had started it, despite having wanted to be surgeons for much of their young adult lives. The findings show that initiatives taken to improve the gender gap must address the multiple underlying factors or they risk making the issue worse. In the UK and Australasia, women account for just 11% of consultant surgeons despite approximately 60% of medical students are women. Although women are at least as able on entry to surgical training only a minority complete it, indicating a deep-rooted issue in the discipline.

Professor Dornan explains: “Previous research has assumed that those who continue to train as surgeons can provide answers to this vexed question. This is fraught with problems when so many senior surgeons are men. This was novel, first, because a young female surgeon did the research, and second because she asked those who know best – women who had chosen to leave. This provided new insights.”

“It is already known that young surgeons endure fatigue, long working hours, difficulty taking time off, strains on personal relationships, and bullying. By analysing leavers’ experiences in depth, we were able to show how these factors discriminated selectively against women. One female former surgical trainee told how she was denied time off to care for her child when a male counterpart was given time off. The request was, apparently, valid when made by a man and invalid when made by a woman.”

Dr Liang comments: “This is just one example of women being treated differently. Rather than being treated as a surgeon requesting leave, they were first and foremost treated as a women requesting leave, which automatically put them at a disadvantage.”

A number of initiatives have been taken to bridge the gender gap and retain women in the profession, which have been ineffective as the gender gap prevails. Professor Nestel said: “Female surgeons experience a wider identity gap between being a member of society and being a surgeon. This has been addressed by trying to improve the situation for women, which risks leaving women feeling even more ostracised. In other words, well intended but ill-informed initiatives may have unintended consequences that aggravates the very situation they are trying to improve. Encouraging female retention may only increase the identity gap as it makes them more aware of the different gender.”

Professor Dornan adds: “For the first time, we can hear the voices of those who have left surgery and understand deep-seated issues that need to be addressed in the long-term. It is only through understanding why or how the problem exists, that we can fix it.”

The timing of the publication coincided with several media stories about the alarming working conditions and experiences that led one female aspirant surgeon to leave surgical practice. The research has received wide media coverage in Australia and internationally. Dr Liang will continue her studies at the University of Melbourne as a PhD candidate and shift her focus to investigating intersectionality and the development of surgical identity.

BBC World News