Discrimination and harassment during orthopaedic surgery audition rotations: a survey of female medical students

Orthopaedic surgery audition rotations afford medical students unparalleled exposure to programs’ cultures and permit mutual determination of “fit”. The prevalence of discrimination and harassment experienced by female medical students, particularly those underrepresented in medicine (URM), during these rotations is unknown. This survey-based study characterizes the frequency of discrimination and harassment among female medical students participating in orthopaedic audition rotations.

A 23-item survey was created to capture the frequency of sexism, sexual harassment/violence, racism, and unconscious bias as well as the effects of these behaviors on well-being and rank lists. Surveys were disseminated to current female residents at 123 accredited orthopaedic surgery programs in the United States. Descriptive statistics include frequencies. Chi-square tests were used to compare non-URM and URM women in subgroup analyses.

In total, 135 surveys were completed (response rate 28%). Most women identified as white (76%), were between 25 and 35 years of age (100%), and had completed audition rotations between 2016 and 2021 (97%). Overall, 80% reported sexist comments and 51% reported sexual harassment. Additionally, 46% recounted racist comments, with significantly higher rates noted among URM women than white women (73% vs. 38%; p = 0.005). Regarding unconscious bias, 93% noted misidentification as non-medical students and 70% were not correctly affiliated with orthopaedic surgery. These experiences were viewed as the norm by 44% of women, and 89% still ranked programs at which these transgressions occurred.

This study not only exposes the relative ubiquity of discrimination and harassment experienced by female medical students during orthopaedic surgery audition rotations, but also that rotators have come to expect and are not fully dissuaded from ranking programs at which these behaviors occur. Efforts to change the culture of orthopaedic surgery are necessary to ensure that rotations and residency programs are free from discrimination and harassment.