1. Chair David S Pisetsky MD PhD Professor of Medicine and Immunology Chief of Rheumatology and Immunology Duke University Medical Center Durham, NC Guests Alison P Toth MD Director, Women's Sports Medicine Program Assistant Professor, Orthopaedic Surgery Duke University Medical Center Durham, NC Thomas P Sculco MD Surgeon-in-Chief and Korein-Wilson Professor of Orthopaedic Surgery Hospital for Special Surgery Chairman of the Department of Orthopaedic Surgery and Professor of Orthopaedic Surgery Weill Medical College of Cornell University New York, NY Women in orthopedic surgery

2. We have a problem The percentage of women entering medical school has increased from 11.1% in 1970 to 47.8% in 2001 The percentage of women in orthopedics has increased from 0.6% in 1970 to 9.0% in 2001 Orthopedic residencies have the lowest percentage of women compared with all other primary surgical specialties Only thoracic surgery, a field entered secondarily after the completion of general surgical training, has a lower percentage Blakemore LC, Hall JM, Biermann, JS. J Bone Joint Surg Am. 2003;85:2477-2480. Alison P Toth MD

3. Blakemore LC, Hall JM, Biermann, JS. J Bone Joint Surg Am. 2003;85:2477-2480. Alison P Toth MD

4. We have a problem—0.6% The percentage of all female residents who choose an orthopedic residency is 0.6%, a number that has not changed over the past twenty years Blakemore LC, Hall JM, Biermann, JS. J Bone Joint Surg Am. 2003;85:2477-2480. Alison P Toth MD

5. We have a recruiting problem Orthopedic surgery has not had the same success in recruiting female trainees that other surgical fields have had There appears to be a leveling of the recruitment rate over the past two decades, indicating that the higher numbers of women entering medicine will not be sufficient to improve gender representation in orthopedic surgery training Blakemore LC, Hall JM, Biermann, JS. J Bone Joint Surg Am. 2003;85:2477-2480. Alison P Toth MD

6. Barriers to recruiting women for orthopedic surgery Leadership Chairman, faculty Nature of the field Physical –Strength –Appeal of power tools, carpentry Lifestyle –Less concerning with resident work-hour restrictions –Trauma call Lack of mentoring Male mentoring/role models Female role models lacking –Practicing orthopedic surgeons (2.3%) Alison P Toth MD

7. Recruiting women into orthopedics at Cornell Introduce women to orthopedics early in their career Provide first-year students with a textbook in musculoskeletal disease Funding 10 research fellowships for medical students, at least half of them going to women Feature our women faculty in interactions with students Involve female faculty in the resident selection process Thomas Sculco MD

8. A female dimension to orthopedics Women tend to be gentler with soft tissue Have excellent psychomotor skills Increase the level of discourse in the OR More empathetic with their patients Thomas Sculco MD

9. Dr Toth’s success story… First encounter with orthopedic surgeons was as an athlete—very common among future surgeons Very encouraging surgeons—excellent mentors Worked in that same clinic every summer and was repeatedly taken to the OR Alison P Toth MD Early active recruitment is important

10. Dr Toth’s success story… As a former athlete, no issues of strength or lifting Did not encounter any obstacles along the way—always treated equally Attitude of not having a chip on the shoulder Alison P Toth MD

11. Different genders, different skills Mere generalization: fine techniques are better accomplished by women—hand, foot and ankle surgery, microvascular etc From experience, dexterity is superior in a woman—less aggressive handling of the tissue Thomas Sculco MD

12. Different genders, different skills: Intrinsic or acquired? Traditionally, girls would sew and boys preferred woodworking Will the evolving gender roles affect the differences in skills? Although women are more oriented towards the crafts, within a year of residency they gain comfort and confidence David Pisetsky MD PhD Thomas Sculco MD

13. Young Alison tinkering with cars Last of three girls Was taught what a boy would have been taught: Building fences Tinkering with cars –Was not intimidated when first taken to the OR due to this experience Alison P Toth MD Early exposure is primary—would imply major society changes

14. Women in the locker room culture Women getting pregnant, delivering, and breast-feeding are alien topics to the locker room culture in the OR Surgeons just have to adapt A lot of women with athletic backgrounds go into orthopedics Thomas Sculco MD

15. Former athletes as surgeons 50-60% of orthopedic residents at Cornell are former athletes; 15-20% were athletes at the collegiate level They like the “team” approach Many may have been treated by team physicians and see them as role models Thomas Sculco MD

16. Dr Toth on being a team physician Cares for 300 division 1 female athletes at Duke Great mentoring to get athletes interested in medicine, sports medicine in particular Great experience getting to know athletes at the game, not just when they come to the office injured Previously assisted the team physician for the New York Giants—always felt respected and appreciated Alison P Toth MD

17. Women must not only be introduced to orthopedics early, but also to the breadth of the field: Metabolic bone disease Trauma Sports medicine Hand and foot surgery Women can play a part in any of these subspecialties and find their niche— there is a place for everyone Thomas Sculco MD Two sets of skills: Hardiness vs dexterity

18. Climbing the academic ladder Dedicated women can move up the ladder Many women may not choose an academic career At Cornell, a woman is director of orthopedic research and is also team physician Such women are role models and more will follow Thomas Sculco MD

19. What about private practice? May be easier, as the surgeon can select a field with less lifting, eg, foot and ankle surgery Private practice allows the regulation of working hours Option not to take call Work part-time In a trauma center, the surgeon must perform all that comes in, all the more difficult tasks Thomas Sculco MD

20. Conclusions Early exposure Show women that they can succeed in the field Women must start looking at men as role models Mentoring should be gender-blind Thomas Sculco MD Alison P Toth MD