Factors Motivating Medical Students in Selecting a Career Specialty: Relevance for a Robust Orthopaedic Pipeline

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To the Editor: I have read with great interest the comprehensive study by Rao et al.1 Their findings and insights should lead us all toward opening the doors for all medical graduates. Humbly, I would like to offer one more comment on this issue.
I find that basic manipulations in orthopaedic traumatology (OT) require a lot more arm force and hand grip strength than is needed in other fields, even when both are undertaken with the proper technique. Did you ever try to get torque in a plate-locking screw while fixing a broken distal femur? While the strong and muscular orthopaedic surgeons handle it well, the slim ones find it quite troublesome.
Physical demand was sparsely evaluated when analyzing the reasons for choosing residencies and fellowships. A single questionnaire conducted in the UK revealed that, when considering orthopaedics residency, the main deterring factor among female medical students was the physical aspect of the job (57%), as opposed to men, who found other career-related issues deterring.2 While it is obvious that stereotypes play a major role, this factor is apparently crucial and should act as a challenge rather than be dismissed by arguments of “misconceptions” and “technique, not strength.”
Because most OT surgeons are men,3-6 the instruments are designed for men and feedback is provided by men. The fine-tuning for the handles, hammers, screwdrivers, retractors, and so on are adapted for a man’s grip.7 A medical student (man or woman) who attends our theater can be offered the opportunity to lock a screw or to insert a nail, but the physically weak ones would find themselves frustrated, as smart and talented they are, by not managing to properly lock a screw. This notion might explain why, when comparing male and female orthopaedics residents’ evaluations, the only parameter in which female residents scored a little less (P = 0.08) was “Technical Skills,”8 although there clearly should not be any difference in technical talent. Perhaps it is not that the revolution skipped us but rather that that we did not adapt to it.
In the surgical equipment aspect, being proactive about gender diversity in orthopaedics means encouraging engineers to redesign instruments—not fitting them to current surgeons, but designing them for all potential surgeons.9 This process would surely not lead to the desired gender equality, but it would break another brick in the wall, adding up to significant changes that yet need to be conducted.1 On the scale between the physically demanding equipment and the long-distance surgeon-controlled robots, we can surely find the right path, which might be as simple as a newly designed screwdriver handle.
Rao et al1 offer readers important data that should be the basis for a mission whose aim would be to make orthopaedic residency relevant to all medical graduates. The surgical equipment aspect should be added to future questionnaires to better understand its influence.
The Authors Reply: Thank you for your kind response to our article.1 You are quite right to point out that ergonomic inefficiencies in the instrumentation we use in orthopaedic surgery may play a role in deterring some women—or men—from pursuing a career in orthopaedic surgery. Anecdotally, from a free text box on our survey questionnaire, we did receive a few comments from female medical students stating that orthopaedics “was like a construction zone,” “don’t like drills/power tools,” and “I can’t lift heavy things like a leg.” However, more of the uninterested female medical students commented on the unwelcome feeling and attitudes they experienced rather than matters relating to strength and orthopaedic equipment.
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