1 Fitting in or opting out: How perceptions of leadership impact on female surgeons’ burnout Dr Kim Peters University of Exeter, UK Prof Michelle Ryan, University of Exeter, UK Miss Helen Fernandes, Neurosurgeon, Cambridge Mrs Scarlett McNally, Orthopaedic Surgeon & DME, East Sussex

Dog-leg in % female McManus & Sproston, 2000

4 The Glass Ceiling

1. The Glass Ceiling Morrison, A. M., White, R. P., & Van Velsor, E. (1987) 2. The Glass Cliff Ryan, M. K. & Haslam, S. A. (2005) 3. The opt-out revolution Belkin, L. (2003)

Other professions Accountants British Army Police force

7 Past Explanations of barriers that women face Sexism Stereotypes Childcare responsibilities Work-life balance Gender pay gap

8 One Recent Explanation…. Focuses women’s choices

9 Feeling Similar to Those Up Top

10 Feeling Similar to Those Up Top Similarity = Fit = Ambition

11

12 Testing the Identity Fit Model Sample 240 surgical trainees; 141 males; years 1-3 Online Questionnaire Own personality Consultant Personality How they fit Career motivation Sacrifice Burnout

13 Identity Fit Model - traits

Trainees viewed consultants as less open, F(1,227=19.11, p<.001) less neurotic, F(1,227=86.61, p<.001) less agreeable, F(1,227= , p<.001) more conscientious, F(1,227= , p<.001) and less extraverted, F(1,227= , p<.001)

15 Identity Fit Model - traits

16 Identity Fit Model - traits

Trainees who perceived their own and Consultants’ personality traits as similar reported: higher fit perceptions (r=.54, p<.001). This in turn predicted higher career ambition (r=.35, p<.001) and lower burnout at work (r=-.37, p<.001).

18 Surgeons and the Identity Fit Model

19 Identity Fit levels

Gender differences with time: By their third year males perceived that they were significantly more similar to consultants than their female colleagues did, F(2,221=3.08, p=.048) Women’s perceptions of fit with consultants decreased with time while men’s perceptions increased, F(2,222=3.52, p=.031). Women’s career ambition decreased more sharply than men’s, F(2,221=2.41, p=.092) Women’s levels of burnout increased while men’s decreased, F(2,221=3.67, p=.027).

21 Identity Fit - career motivation

22 Identity Fit Interventions The WinS Conference

23 Identity Fit Interventions The SAS Leadership Course

Perception of fit + Self efficacy TWO ways to increase motivation: Increase perception of fitting into the group – e.g. visible positive role models similar to the trainees Increase the individual’s own perception of their ability to succeed (self efficacy) by increasing skill level.

Equality = treating everyone as if they are the same Diversity = acknowledging (embracing) everyone being different, with different experiences

Referrals to NCAS

It looks WORSE now… Surgery now going for THIRD year core Run-through stopped for surgery Money down for part-time training Perception that money down for part-time training

Age & hurdles HO SHO Reg SR FY1FY2CT1CT2ST3ST4ST5ST6ST7ST8

What happens at age 29? 133 conceptions per 1000 women age Age 27 is median age for first pregnancy Age 29 is median age for first marriage IVF success rate falls from 25% at age 35 to 8% at age 40 Apply for Surgical Specialty Training AND /OR…

IVF success rate by age

As trainers: The years of child-rearing coincide with surgical training There are 25 more years in a career post-babies We need to support women Discrimination is in favour of women

Correlation female applicants with competitiveness of specialty, 2005 McNally, JRSM, 2008

As Educational leaders 13% of applicants to surgery are female We need more Plan B options for everyone (ACCS is too complex. Emergency Medicine was good exit) More visible part-time training options Money with trainee TARIFF No job-share partners in surgery Zero tolerance for poor trainers Get rid of New Deal (EWTR is OK!)

34 Conclusions of perception of fit study “Fit” is important –It affects motivation and success Fit is affected by context –The training environment is different for males and females Interventions work –Increase self efficacy –Increase positive perceptions of surgery “Fit” perceptions are malleable

Thank you!

Supporting Excellence In Medical Education 9th National Multi-specialty Conference for Heads of Schools, Programme Directors, Directors of Medical Education 25 & 26 th January 2011 C O G P E D