Barriers and facilitators for female practitioners in orthopaedic training and practice: a scoping review

Abstract

Despite advances in medical education and professional opportunities, orthopaedic surgery remains the least gender-diverse medical specialty, with women significantly underrepresented globally. This scoping review aims to synthesize existing literature to provide a comprehensive overview of the barriers and facilitators encountered by females in orthopaedic surgery training and practice. A comprehensive search of Medline (OVID), Scopus, Embase, Emcare, and CINAHL was performed from inception to 14 July 2024. Additional sources were identified via citation searching and Google Scholar. Any primary studies employing qualitative, quantitative, or mixed methods approaches to explore barriers and facilitators experienced by female orthopaedic trainees and consultants in high-income countries. Quality analysis of included articles was conducted using the Mixed Methods Appraisal Tool. Seventy-nine studies met the inclusion criteria, involving over 100 000 participants between 1993 and 2024. Most studies were cross-sectional surveys. Sixty-eight barriers and 38 facilitators were identified. Analysis using the Socio-Ecological Model revealed the complex interplay of factors at the individual, interpersonal, organizational, community, and policy levels. The largest proportion of barriers and facilitators resided at the organizational level. This scoping review provides a comprehensive mapping of current evidence on barriers and facilitators for female practitioners in orthopaedic surgery training and practice. The findings suggest the need for multifaceted interventions to promote gender equity. Future research should evaluate the effectiveness of specific interventions and develop strategies to support women in orthopaedics, ultimately contributing to a more inclusive and diverse workforce.