Support, mentor and empower: female cardiothoracic surgeons across Europe and the role of the society

Training and continuation of education in cardiothoracic surgery (CTS) across Europe and around the world are multifaceted and influenced by financial income, familial support and cultural borders [1]. In addition, the experiences of female cardiac surgeons depend on their country of work. The authors’ introductory words highlight the complexities found at the centre of the survey, because training and working conditions vary profoundly across Europe [2]. To draw a conclusion from the data of over 1000 participants is difficult; however, the statistics demonstrate that 67% of female surgeons reported experiencing discrimination at work, i.e. they were unfairly treated due to their gender [3]. Despite potential type 1 and 2 errors due to the conceptualization of the survey and the percentage of respondents, the results catch the attention of the reader. Most of the women surveyed experienced gender discrimination and thought about leaving the speciality as a result. Consequently, Pompili et al. concluded that gender bias may prevent qualified women from advancing in positions of leadership. Improvements in the workplace such as in-hospital childcare arrangements, formal mentorship and protected academic time were found to play a significant role regarding work satisfaction.

Creating a dedicated committee for women in CTS in 2021, the EACTS reacted 35 years after its founding in 1986 to an inevitable sign of the times. One may say that this development took quite some time compared to the reaction times of our partner societies abroad. The role of the professional society is to deliver education and training for every talented and motivated surgeon, and this role should apply inclusively to all its members. How can EACTS learn from other societies and utilize new technologies to mitigate the gender gap across Europe and motivate more young women to become cardiothoracic surgeons?

One of the first committees to promote the visibility of women in thoracic surgery was The Women in Thoracic Surgery (WTS) organization in the USA, founded in 1986 [4]. Providing 7 different awards including gender-paired mentorships, the WTS Scholarship Program demonstrated its potentials by providing training, research and networking opportunities for female surgeons that increased work satisfaction and led to growing numbers of board-certified female surgeons from 2012 to 2020. As demonstrated in the USA, targeted efforts to support women surgeons have been successful as evidenced by improved retention and reduced attrition along the CTS training pipeline [5]. In general, these strategies should be adapted for all trainees. Effective mentorship in CTS is difficult to find, regardless of gender. Reich et al. [6] found in their survey that over half of the respondents reported receiving less effective or no mentorship at all, and most mentors reported not having received education on mentorship. This result was not associated with gender. Certainly, our society should appoint mentors who ensure the continuation of high-quality standards; this approach will provide an advantage not only for female but also for male trainees and demonstrate a valuable project our society should embark on in the future.

In the last decade, the influence of social media has expanded into the people’s work routines. The WTS early on established their visibility through Facebook, Twitter and Instagram using a tool that originally derived from the idea to share experiences by texts, pictures and videos to gather followers and inspire audiences without any limitations in time and place. The availability of social media also may help reduce the lack of female mentorship. First, multiple trainees can be reached by 1 person. If young female surgeons do not have any female mentors in their department, they can reach out through social media, join groups and research projects and extend their network without necessarily being bound to any time zone. Second, communication through social media increases awareness. Luc et al. [7] showed that focusing on the dissemination of publications through short communications, namely Twitter, improves article metric scores by reaching a greater audience. The same principle can be adapted to multiply the voices of female surgeons supported by the European societies to increase visibility and awareness of female-lead projects, meetings and workshops.

The timing to motivate young people in CTS is crucial and does not start at the level of the junior resident. Miller et al. [8] showed that interest in CTS is lower in female than in male medical students. More than 30% of women interested in CTS reported mentorship as the most important factor in their decision. Involving more students in EACTS activities through early mentorship and face-to-face courses and ward rounds in the CTS centres can be an important stepping stone, as demonstrated successfully by the Junges Forum of the German Society for Thoracic and Cardiovascular Surgery [9]. Special basic courses during the annual meeting and inexpensive online events should be actively advertised for medical students.

It may be more difficult to deal with personal aspects of life than structured educational opportunities. The differences might be regulated by country-specific conditions like familial support and financial income. It is unquestionable that new family-friendly policies will have the indirect effect of encouraging female colleagues to enter and remain in academic careers. Such policies require a profound change in the structure of departments to make operating room plans more flexible, for example, having 2 operators share the list in 1 theatre. Future leadership courses organized by EACTS might be professionally designed so that young female surgeons will not remain clustered in the junior ranks and to reorganize institutional traditions for the advantage of the whole team by focusing on working hours, effective time management and protected research time.

Multiple exciting pathways exist for the newly founded Women in Cardiothoracic Surgery committee to empower women in CTS across Europe where diversity in the job situation could not be more pronounced. By creating the Women in Cardiothoracic Surgery committee, EACTS makes a big step forward for both female and male surgeons to not only mitigate the gender gap but also standardize high-quality education, equalize possibilities and consequently achieve a highly professionalized cardiothoracic society.

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