From ill-fitting instruments to assumptions about competence, surgical culture sidelines women, first Canadian study of its kind suggests

Women now make up over half of medical students in Canada, but only one-third of practising surgeons. A new study suggests part of the gap stems from gender norms embedded in workplace culture. The researchers at McGill University say subtle but persistent biases may be driving women out of the field.

“A lot of research into the gender gap in surgery has focused on increasing the number of women, but there wasn’t much on what day-to-day life actually felt like for women,” said lead author Dr. Jillian Schneidman, who graduated from McGill’s Faculty of Medicine and Health Sciences this year with an MD.

To fill that gap, Schneidman conducted the first ethnographic study of women in surgery in Canada. Published in The American Journal of Surgery, the study draws on 67 hours of operating room observation and in-depth interviews with female surgeons at a Canadian teaching hospital.

The findings point to a surgical world that continues to reflect a masculine norm, affecting everything from who gets complex cases to how instruments are designed. While work-life balance and family demands are often cited as barriers for women, Schneidman said the deeper issue is structural.

“Women’s surgical status is continually questioned and undermined,” said Schneidman, who conducted the research while completing a master’s in medical anthropology at Oxford University.

Participants reported being passed over for surgical referrals, paid less for equivalent procedures and working with tools too large for their hands. One surgeon even chose her specialty because the instruments in another field were too big for her to grip, she said.

Schneidman found that gender shaped surgical life on three levels: organizationally, women were overlooked for patient referrals, given less time in the operating room, paid less and often seen as less legitimate surgeons; individually, they faced pressure to be confident and assertive, but not so much that they risked being seen as “unfeminine”; and environmentally, surgical spaces and tools were built with men in mind. One operating room sign even listed the required head covering as a “men’s hat.”

She points out that surgical culture isn’t just an equity issue, it’s about patient care.

“Diverse care teams better reflect the diverse patient population,” she said, noting recent studies that link female surgeons and more diverse teams to better outcomes for patients.

Now beginning her general surgery residency at McGill, Schneidman said her next study is exploring how female surgeons navigate structural exclusion, especially the ways they downplay or internalize bias to succeed.

About the study

“Women in surgery: The social construction of gender in surgical practice” by Jillian Schneidman, Kathleen Rice and Neil Armstrong was published in The American Journal of Surgery.