Elsevier

World Neurosurgery

Volume 104, August 2017, Pages 48-60
World Neurosurgery

Women in Neurosurgery
E-WIN Project 2016: Evaluating the Current Gender Situation in Neurosurgery Across Europe—An Interactive, Multiple-Level Survey

https://doi.org/10.1016/j.wneu.2017.04.094Get rights and content

Background

The proportion of women among neurosurgeons appears to be growing worldwide with time. Official data concerning the current situation across Europe have not yet been published. Thus, there are still concerns about gender inequality. The European Women in Neurosurgery Project 2016 was designed to recognize the current situation across Europe.

Methods

The office holders of the national neurosurgical societies of 39 countries forming the European Association of Neurosurgical Societies were contacted to provide data stating the proportion of women in neurosurgery. Obtained data were supplied with the results of an online survey.

Results

The response rate of national office holders was 90%. The number of reported neurosurgeons was 12,985, and overall proportion of women represented was 12%. Two hundred thirty-seven responses to online questionnaire were taken into account. The overall proportion of female respondents was 30%. There was no intergender variability in responses regarding amount of working time per week, exposure to surgeries, or administrative work. Male respondents reported dedicating significantly more time to scientific work and feeling more confident dictating own career direction. Female respondents reported being less often married, having fewer children, a stronger perception of gender significance level, and a higher appreciation of personal qualities.

Conclusions

Neurosurgery is a challenging field of medicine. The results of our survey did not imply an overall feeling of gender inequality among European respondents, although women believe that the gender issue to be more important than men do and that they have to sacrifice more of their personal lives.

Introduction

Neurosurgery has always been a challenging field of medicine, requiring more than just physical and psychical strength, brightness, self-confidence, competitiveness, courage, or highly developed social skills. Consequently, the individuals attracted present an extreme level of discipline and self-organization, a willingness to accommodate to a particular lifestyle to do the work to master and advance in the field.1 No official “gender proclamation” has ever been stated regarding a “proper” candidate for neurosurgery, nor can evidence be found in the scientific literature explaining the emergence of this kind of division. Nevertheless, neurosurgery has been regarded as male-dominated for decades, incorporating a small proportion of women that appears to be growing slowly worldwide.1, 2, 3, 4, 5, 6, 7

Several reports have been published describing the current gender situation among neurosurgeons in the United States and North America. The most recent data presented by Renfrow at al.2 show the positive trend in female neurosurgical residents' enrolment; however, the authors highlight the evident disparity between male (5.3%) and female (17%) attrition rates during residency. These and several other authors have also expressed their concerns about “gender inequality.”2, 3, 4, 5, 6, 7, 8 To our knowledge, official data displaying the current gender allocation among neurosurgeons across Europe or personal statements addressing this particular problem have not been published.

The European Women in Neurosurgery (E-WIN) Project 2016 was designed to recognize the current situation across Europe, and to address and critically evaluate the possible existence of gender inequality in our continent.

Section snippets

Methods

The survey consisted of two steps. First, we sought a critical evaluation of the current situation across individual European countries. To fulfill this requirement, the office holders of national neurosurgical societies from the 39 countries that form the basis of the European Association of Neurosurgical Societies (EANS; https://eans.org/pages/about-us/societies) were contacted by e-mail and asked to provide (1) the total number of neurosurgeons registered by national society to date, with

Statistical Methods

Statistical testing was based on 2-tailed t tests for normally distributed continuous variables, and chi-square or Fisher tests were used for comparison of categorical variables, as appropriate. Statistical significance was established at P < 0.05. All statistical computations were performed using Statistica version 12.0 software (StatSoft, Tulsa, Oklahoma, USA).

Proportion of Women in Neurosurgery

The response rate of contacted office holders of national neurosurgical societies from the 39 countries that form the basis of EANS was 90% (35/39). Representatives from Armenia, Macedonia, Norway, and Slovenia did not provide any of the required information. The total number of reported neurosurgeons in responding countries was 12,985, and the overall proportion of female neurosurgeons was 12% (1565/12,985). The highest overall proportion of female neurosurgeons was reported in Italy

Discussion

The first aim of this study is a systematic description of the status of women in European neurosurgery. The results of this study suggest increasing the number of women in neurosurgery across all European countries. Women are systematically better represented in the proportion of residents than in the proportion of qualified neurosurgeons (Figure 2). There is apparently a lower proportion of women in Eastern European countries; this holds true for data obtained from national societies and that

Limitations

The main limitation of this study is the individual response rate of approximately 20%, assuming 237 completed questionnaires by 1118 EANS individual members from European countries. As mentioned in Methods section, there were multiple ways to recruit participants; however, the primary method was direct contact through EANS organization mailing list. Other methods were indirect, and we believe it is reasonable to compute participation rate as we did. We are aware that the number is an upper

Strengths

The first aim of this study is a systematic description of the number of women in European neurosurgery using a data set from the national databases of European countries associated with EANS. Furthermore, opinions of neurosurgeons of both genders on necessary qualities and strengths for neurosurgical practice were studied among respondents to this online survey. Finally, it demonstrates the role of the EANS as an organization able to fulfil a scientific role in organizing such a study of

Conclusions

Neurosurgery is a challenging, inherently demanding field of medicine. The primary goal should be to attract the best and the brightest candidates who are passionate about the specialty, regardless of gender or other discriminations. The results of our survey did not imply the overall feeling of gender inequality among European respondents, although women believe that the gender issue is more important than men do and that they have to sacrifice more of their personal lives. These

Acknowledgments

We thank Liz Derow for help with English-language editing.

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    Conflict of interest statement: The authors declare that the article content was composed in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

    Czech Ministry of Defense (grant MO1012) provided financial support. The sponsor had no role in the design or conduct of this research.

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