{"id":"https://openalex.org/W4414932001","doi":"https://doi.org/10.1186/s13018-025-05919-5","title":"The \u2018leaky pipeline\u2019 in orthopaedic surgery: why female trainees drop out?","display_name":"The \u2018leaky pipeline\u2019 in orthopaedic surgery: why female trainees drop out?","publication_year":2025,"publication_date":"2025-10-08","ids":{"openalex":"https://openalex.org/W4414932001","doi":"https://doi.org/10.1186/s13018-025-05919-5","pmid":"https://pubmed.ncbi.nlm.nih.gov/41063315","pmcid":"https://www.ncbi.nlm.nih.gov/pmc/articles/12505790"},"language":"en","primary_location":{"id":"doi:10.1186/s13018-025-05919-5","doi":"https://doi.org/10.1186/s13018-025-05919-5","is_oa":true,"landing_page_url":"https://doi.org/10.1186/s13018-025-05919-5","pdf_url":"https://josr-online.biomedcentral.com/counter/pdf/10.1186/s13018-025-05919-5","source":{"id":"https://openalex.org/S160567915","display_name":"Journal of Orthopaedic Surgery and Research","issn_l":"1749-799X","issn":["1749-799X"],"is_oa":true,"is_in_doaj":true,"is_core":true,"listed_in":["cwts-core","doaj","dongbi-d","doyens","jufo-1","ki-jl-1","medline","norway-1","oarl","poland-70","russia-white-list-2"],"host_organization":"https://openalex.org/P4310320256","host_organization_name":"BioMed Central","host_organization_lineage":["https://openalex.org/P4310320256","https://openalex.org/P4310319965"],"host_organization_lineage_names":["BioMed Central","Springer Nature"],"type":"journal"},"license":"cc-by-nc-nd","license_id":"https://openalex.org/licenses/cc-by-nc-nd","version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"Journal of Orthopaedic Surgery and Research","raw_type":"journal-article"},"volume":null,"type":"article","is_traditional":true,"indexed_in":["crossref","doaj","pubmed"],"open_access":{"is_oa":true,"oa_status":"gold","oa_url":"https://josr-online.biomedcentral.com/counter/pdf/10.1186/s13018-025-05919-5","any_repository_has_fulltext":true},"authorships":[{"author_position":"first","author":{"id":"https://openalex.org/A5108985752","display_name":"Ahmad Furqan Anjum","orcid":"https://orcid.org/0009-0005-9616-0969","observed_orcids":["https://orcid.org/0009-0005-9616-0969"]},"institutions":[{"id":"https://openalex.org/I4210163284","display_name":"Shaikh Zayed Postgraduate Medical Institute","ror":"https://ror.org/058prbp42","country_code":"PK","type":"healthcare","lineage":["https://openalex.org/I4210163284"]}],"countries":["PK"],"is_corresponding":true,"raw_author_name":"Ahmad Furqan Anjum","raw_affiliation_strings":["Shaikh Khalifa Bin Zayed Al-Nahyan Medical College, Shaikh Zayed Postgraduate Medical Institute (SZPGMI), Lahore, Punjab, Pakistan. ahmadfurqananjum31@gmail.com","Shaikh Khalifa Bin Zayed Al-Nahyan Medical College, Shaikh Zayed Postgraduate Medical Institute (SZPGMI), Lahore, Punjab, Pakistan"],"raw_orcid":"https://orcid.org/0009-0005-9616-0969","affiliations":[{"raw_affiliation_string":"Shaikh Khalifa Bin Zayed Al-Nahyan Medical College, Shaikh Zayed Postgraduate Medical Institute (SZPGMI), Lahore, Punjab, Pakistan. ahmadfurqananjum31@gmail.com","institution_ids":["https://openalex.org/I4210163284"]},{"raw_affiliation_string":"Shaikh Khalifa Bin Zayed Al-Nahyan Medical College, Shaikh Zayed Postgraduate Medical Institute (SZPGMI), Lahore, Punjab, Pakistan","institution_ids":["https://openalex.org/I4210163284"]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5113384782","display_name":"Muhammad Burhan Anjum","orcid":"https://orcid.org/0009-0004-4794-8461","observed_orcids":["https://orcid.org/0009-0004-4794-8461"]},"institutions":[{"id":"https://openalex.org/I4405261637","display_name":"Akhtar Saeed Medical and Dental College","ror":"https://ror.org/05kyfde14","country_code":"PK","type":"education","lineage":["https://openalex.org/I4405261637"]}],"countries":["PK"],"is_corresponding":false,"raw_author_name":"Muhammad Burhan Anjum","raw_affiliation_strings":["Akhtar Saeed Medical and Dental College, Lahore, Punjab, Pakistan"],"raw_orcid":"https://orcid.org/0009-0004-4794-8461","affiliations":[{"raw_affiliation_string":"Akhtar Saeed Medical and Dental College, Lahore, Punjab, Pakistan","institution_ids":["https://openalex.org/I4405261637"]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5107266088","display_name":"Rahmeen Nauman","orcid":"https://orcid.org/0009-0004-0242-818X","observed_orcids":["https://orcid.org/0009-0004-0242-818X"]},"institutions":[{"id":"https://openalex.org/I142016965","display_name":"King Edward Medical University","ror":"https://ror.org/02rrbpf42","country_code":"PK","type":"education","lineage":["https://openalex.org/I142016965"]}],"countries":["PK"],"is_corresponding":false,"raw_author_name":"Rahmeen Nauman","raw_affiliation_strings":["King Edward Medical University, Lahore, Punjab, Pakistan"],"raw_orcid":"https://orcid.org/0009-0004-0242-818X","affiliations":[{"raw_affiliation_string":"King Edward Medical University, Lahore, Punjab, Pakistan","institution_ids":["https://openalex.org/I142016965"]}]},{"author_position":"last","author":{"id":"https://openalex.org/A5056750138","display_name":"Rekha Rana","orcid":null,"observed_orcids":[]},"institutions":[{"id":"https://openalex.org/I4210163284","display_name":"Shaikh Zayed Postgraduate Medical Institute","ror":"https://ror.org/058prbp42","country_code":"PK","type":"healthcare","lineage":["https://openalex.org/I4210163284"]}],"countries":["PK"],"is_corresponding":false,"raw_author_name":"Raza ur Rehman Rana","raw_affiliation_strings":["Shaikh Khalifa Bin Zayed Al-Nahyan Medical College, Shaikh Zayed Postgraduate Medical Institute (SZPGMI), Lahore, Punjab, Pakistan"],"raw_orcid":"https://orcid.org/0009-0003-5173-5023","affiliations":[{"raw_affiliation_string":"Shaikh Khalifa Bin Zayed Al-Nahyan Medical College, Shaikh Zayed Postgraduate Medical Institute (SZPGMI), Lahore, Punjab, Pakistan","institution_ids":["https://openalex.org/I4210163284"]}]}],"institutions":[],"countries_distinct_count":1,"institutions_distinct_count":3,"corresponding_author_ids":["https://openalex.org/A5108985752"],"corresponding_institution_ids":["https://openalex.org/I4210163284"],"apc_list":{"value":3090,"currency":"USD","value_usd":3090},"apc_paid":{"value":3090,"currency":"USD","value_usd":3090},"fwci":4.2996,"has_fulltext":true,"cited_by_count":4,"citation_normalized_percentile":{"value":0.92885962,"is_in_top_1_percent":false,"is_in_top_10_percent":true},"cited_by_percentile_year":{"min":89,"max":97},"biblio":{"volume":"20","issue":"1","first_page":"881","last_page":"881"},"is_retracted":false,"is_paratext":false,"is_xpac":false,"primary_topic":{"id":"https://openalex.org/T10843","display_name":"Diversity and Career in Medicine","score":1.0,"subfield":{"id":"https://openalex.org/subfields/3318","display_name":"Gender Studies"},"field":{"id":"https://openalex.org/fields/33","display_name":"Social Sciences"},"domain":{"id":"https://openalex.org/domains/2","display_name":"Social Sciences"}},"topics":[{"id":"https://openalex.org/T10843","display_name":"Diversity and Career in Medicine","score":1.0,"subfield":{"id":"https://openalex.org/subfields/3318","display_name":"Gender Studies"},"field":{"id":"https://openalex.org/fields/33","display_name":"Social Sciences"},"domain":{"id":"https://openalex.org/domains/2","display_name":"Social Sciences"}},{"id":"https://openalex.org/T10726","display_name":"Career Development and Diversity","score":9.999999747378752e-05,"subfield":{"id":"https://openalex.org/subfields/3202","display_name":"Applied Psychology"},"field":{"id":"https://openalex.org/fields/32","display_name":"Psychology"},"domain":{"id":"https://openalex.org/domains/2","display_name":"Social Sciences"}},{"id":"https://openalex.org/T13252","display_name":"Sex and Gender in Healthcare","score":9.999999747378752e-05,"subfield":{"id":"https://openalex.org/subfields/2739","display_name":"Public Health, Environmental and Occupational Health"},"field":{"id":"https://openalex.org/fields/27","display_name":"Medicine"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}}],"keywords":[{"id":"https://openalex.org/keywords/leaky-pipeline","display_name":"leaky pipeline","score":0.9919999837875366},{"id":"https://openalex.org/keywords/gender-equity-in-surgery","display_name":"gender equity in surgery","score":0.6679999828338623},{"id":"https://openalex.org/keywords/trainee-attrition","display_name":"trainee attrition","score":0.847000002861023},{"id":"https://openalex.org/keywords/employment-discrimination","display_name":"employment discrimination","score":0.7850000262260437},{"id":"https://openalex.org/keywords/microaggressions","display_name":"microaggressions","score":0.8460000157356262},{"id":"https://openalex.org/keywords/mentorship-and-sponsorship","display_name":"mentorship and sponsorship","score":0.9580000042915344},{"id":"https://openalex.org/keywords/work-life-balance","display_name":"work-life balance","score":0.9610000252723694},{"id":"https://openalex.org/keywords/parental-leave","display_name":"parental leave","score":0.7250000238418579},{"id":"https://openalex.org/keywords/family-friendly-workplace-policies","display_name":"family-friendly workplace policies","score":0.6600000262260437},{"id":"https://openalex.org/keywords/implicit-bias","display_name":"implicit bias","score":0.6620000004768372},{"id":"https://openalex.org/keywords/gender-stereotypes","display_name":"gender stereotypes","score":0.6359999775886536},{"id":"https://openalex.org/keywords/surgical-workforce-diversity","display_name":"surgical workforce diversity","score":0.5669999718666077}],"concepts":[{"id":"https://openalex.org/C71924100","wikidata":"https://www.wikidata.org/wiki/Q11190","display_name":"Medicine","level":0,"score":0.8855000138282776},{"id":"https://openalex.org/C188198153","wikidata":"https://www.wikidata.org/wiki/Q1613840","display_name":"Limiting","level":2,"score":0.7949000000953674},{"id":"https://openalex.org/C68312169","wikidata":"https://www.wikidata.org/wiki/Q216685","display_name":"Orthopedic surgery","level":2,"score":0.714900016784668},{"id":"https://openalex.org/C199728807","wikidata":"https://www.wikidata.org/wiki/Q2578557","display_name":"Equity (law)","level":2,"score":0.487199991941452},{"id":"https://openalex.org/C2984949393","wikidata":"https://www.wikidata.org/wiki/Q1260241","display_name":"Drop out","level":2,"score":0.4821999967098236},{"id":"https://openalex.org/C509550671","wikidata":"https://www.wikidata.org/wiki/Q126945","display_name":"Medical education","level":1,"score":0.3522000014781952},{"id":"https://openalex.org/C2984776528","wikidata":"https://www.wikidata.org/wiki/Q113453","display_name":"Gender equity","level":2,"score":0.3375999927520752},{"id":"https://openalex.org/C1862650","wikidata":"https://www.wikidata.org/wiki/Q186005","display_name":"Physical therapy","level":1,"score":0.3352000117301941},{"id":"https://openalex.org/C159110408","wikidata":"https://www.wikidata.org/wiki/Q121176","display_name":"Nursing","level":1,"score":0.31189998984336853},{"id":"https://openalex.org/C43521106","wikidata":"https://www.wikidata.org/wiki/Q2165493","display_name":"Pipeline (software)","level":2,"score":0.3100999891757965},{"id":"https://openalex.org/C2781345722","wikidata":"https://www.wikidata.org/wiki/Q5308388","display_name":"Drop (telecommunication)","level":2,"score":0.30660000443458557},{"id":"https://openalex.org/C512399662","wikidata":"https://www.wikidata.org/wiki/Q3505712","display_name":"Family medicine","level":1,"score":0.2856999933719635},{"id":"https://openalex.org/C2992299759","wikidata":"https://www.wikidata.org/wiki/Q113453","display_name":"Gender equality","level":2,"score":0.28139999508857727},{"id":"https://openalex.org/C141071460","wikidata":"https://www.wikidata.org/wiki/Q40821","display_name":"Surgery","level":1,"score":0.26759999990463257},{"id":"https://openalex.org/C2779473830","wikidata":"https://www.wikidata.org/wiki/Q1540899","display_name":"MEDLINE","level":2,"score":0.25940001010894775},{"id":"https://openalex.org/C2989236134","wikidata":"https://www.wikidata.org/wiki/Q31207","display_name":"Patient care","level":2,"score":0.25769999623298645}],"mesh":[{"descriptor_ui":"D000072161","descriptor_name":"Orthopedic Surgeons","qualifier_ui":"Q000193","qualifier_name":"education","is_major_topic":true},{"descriptor_ui":"D000072161","descriptor_name":"Orthopedic Surgeons","qualifier_ui":"Q000523","qualifier_name":"psychology","is_major_topic":true},{"descriptor_ui":"D000072358","descriptor_name":"Work-Life Balance","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false},{"descriptor_ui":"D000084803","descriptor_name":"Gender Equity","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false},{"descriptor_ui":"D002321","descriptor_name":"Career Choice","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false},{"descriptor_ui":"D002322","descriptor_name":"Career Mobility","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false},{"descriptor_ui":"D005260","descriptor_name":"Female","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false},{"descriptor_ui":"D006801","descriptor_name":"Humans","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false},{"descriptor_ui":"D008611","descriptor_name":"Mentors","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false},{"descriptor_ui":"D009985","descriptor_name":"Orthopedics","qualifier_ui":"Q000193","qualifier_name":"education","is_major_topic":true},{"descriptor_ui":"D010822","descriptor_name":"Physicians, Women","qualifier_ui":"Q000523","qualifier_name":"psychology","is_major_topic":true},{"descriptor_ui":"D063507","descriptor_name":"Sexism","qualifier_ui":null,"qualifier_name":null,"is_major_topic":true}],"locations_count":5,"locations":[{"id":"doi:10.1186/s13018-025-05919-5","doi":"https://doi.org/10.1186/s13018-025-05919-5","is_oa":true,"landing_page_url":"https://doi.org/10.1186/s13018-025-05919-5","pdf_url":"https://josr-online.biomedcentral.com/counter/pdf/10.1186/s13018-025-05919-5","source":{"id":"https://openalex.org/S160567915","display_name":"Journal of Orthopaedic Surgery and Research","issn_l":"1749-799X","issn":["1749-799X"],"is_oa":true,"is_in_doaj":true,"is_core":true,"listed_in":["cwts-core","doaj","dongbi-d","doyens","jufo-1","ki-jl-1","medline","norway-1","oarl","poland-70","russia-white-list-2"],"host_organization":"https://openalex.org/P4310320256","host_organization_name":"BioMed Central","host_organization_lineage":["https://openalex.org/P4310320256","https://openalex.org/P4310319965"],"host_organization_lineage_names":["BioMed Central","Springer Nature"],"type":"journal"},"license":"cc-by-nc-nd","license_id":"https://openalex.org/licenses/cc-by-nc-nd","version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"Journal of Orthopaedic Surgery and Research","raw_type":"journal-article"},{"id":"pmh:oai:europepmc.org:11313715","doi":null,"is_oa":true,"landing_page_url":"https://www.ncbi.nlm.nih.gov/pmc/articles/12505790","pdf_url":null,"source":{"id":"https://openalex.org/S4306400806","display_name":"Europe PMC (PubMed Central)","issn_l":null,"issn":null,"is_oa":false,"is_in_doaj":false,"is_core":false,"listed_in":[],"host_organization":"https://openalex.org/I1303153112","host_organization_name":"European Bioinformatics Institute","host_organization_lineage":["https://openalex.org/I1303153112"],"host_organization_lineage_names":[],"type":"repository"},"license":"cc-by-nc-nd","license_id":"https://openalex.org/licenses/cc-by-nc-nd","version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":null,"raw_type":"Text"},{"id":"pmid:41063315","doi":null,"is_oa":false,"landing_page_url":"https://pubmed.ncbi.nlm.nih.gov/41063315","pdf_url":null,"source":{"id":"https://openalex.org/S4306525036","display_name":"PubMed","issn_l":null,"issn":null,"is_oa":false,"is_in_doaj":false,"is_core":false,"listed_in":[],"host_organization":"https://openalex.org/I1299303238","host_organization_name":"National Institutes of Health","host_organization_lineage":["https://openalex.org/I1299303238"],"host_organization_lineage_names":[],"type":"repository"},"license":null,"license_id":null,"version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"Journal of orthopaedic surgery and research","raw_type":"Letter"},{"id":"pmh:oai:pubmedcentral.nih.gov:12505790","doi":null,"is_oa":true,"landing_page_url":"https://pmc.ncbi.nlm.nih.gov/articles/PMC12505790/","pdf_url":null,"source":{"id":"https://openalex.org/S2764455111","display_name":"PubMed Central","issn_l":null,"issn":null,"is_oa":true,"is_in_doaj":false,"is_core":false,"listed_in":[],"host_organization":"https://openalex.org/I1299303238","host_organization_name":"National Institutes of Health","host_organization_lineage":["https://openalex.org/I1299303238"],"host_organization_lineage_names":[],"type":"repository"},"license":"cc-by-nc-nd","license_id":"https://openalex.org/licenses/cc-by-nc-nd","version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"J Orthop Surg Res","raw_type":"Text"},{"id":"pmh:oai:doaj.org/article:6ef33ec604b3433cb5e2dd4ce9878d7d","doi":null,"is_oa":true,"landing_page_url":"https://doaj.org/article/6ef33ec604b3433cb5e2dd4ce9878d7d","pdf_url":null,"source":{"id":"https://openalex.org/S4306401280","display_name":"DOAJ (DOAJ: Directory of Open Access Journals)","issn_l":null,"issn":null,"is_oa":false,"is_in_doaj":false,"is_core":false,"listed_in":[],"host_organization":null,"host_organization_name":null,"host_organization_lineage":[],"host_organization_lineage_names":[],"type":"repository"},"license":"cc-by-sa","license_id":"https://openalex.org/licenses/cc-by-sa","version":"submittedVersion","is_accepted":false,"is_published":false,"raw_source_name":"Journal of Orthopaedic Surgery and Research, Vol 20, Iss 1, Pp 1-5 (2025)","raw_type":"article"}],"best_oa_location":{"id":"doi:10.1186/s13018-025-05919-5","doi":"https://doi.org/10.1186/s13018-025-05919-5","is_oa":true,"landing_page_url":"https://doi.org/10.1186/s13018-025-05919-5","pdf_url":"https://josr-online.biomedcentral.com/counter/pdf/10.1186/s13018-025-05919-5","source":{"id":"https://openalex.org/S160567915","display_name":"Journal of Orthopaedic Surgery and Research","issn_l":"1749-799X","issn":["1749-799X"],"is_oa":true,"is_in_doaj":true,"is_core":true,"listed_in":["cwts-core","doaj","dongbi-d","doyens","jufo-1","ki-jl-1","medline","norway-1","oarl","poland-70","russia-white-list-2"],"host_organization":"https://openalex.org/P4310320256","host_organization_name":"BioMed Central","host_organization_lineage":["https://openalex.org/P4310320256","https://openalex.org/P4310319965"],"host_organization_lineage_names":["BioMed Central","Springer Nature"],"type":"journal"},"license":"cc-by-nc-nd","license_id":"https://openalex.org/licenses/cc-by-nc-nd","version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"Journal of Orthopaedic Surgery and Research","raw_type":"journal-article"},"sustainable_development_goals":[{"score":1.0,"id":"https://metadata.un.org/sdg/10","display_name":"Reduced inequalities"},{"score":0.9444000124931335,"id":"https://metadata.un.org/sdg/5","display_name":"Gender equality"},{"score":0.8560000061988831,"id":"https://metadata.un.org/sdg/3","display_name":"Good health and well-being"}],"study_designs":[],"awards":[],"funders":[],"has_content":{"pdf":true,"grobid_xml":true},"content_urls":{"pdf":"https://content.openalex.org/works/W4414932001.pdf","grobid_xml":"https://content.openalex.org/works/W4414932001.grobid-xml"},"referenced_works_count":21,"referenced_works":["https://openalex.org/W2412044783","https://openalex.org/W2956634606","https://openalex.org/W3045243135","https://openalex.org/W3093775032","https://openalex.org/W3203990052","https://openalex.org/W3209000271","https://openalex.org/W3217641684","https://openalex.org/W4223517551","https://openalex.org/W4281255019","https://openalex.org/W4284702233","https://openalex.org/W4306178293","https://openalex.org/W4319461850","https://openalex.org/W4366601882","https://openalex.org/W4378781847","https://openalex.org/W4386923302","https://openalex.org/W4392200693","https://openalex.org/W4399195533","https://openalex.org/W4404548061","https://openalex.org/W4404628910","https://openalex.org/W4406067984","https://openalex.org/W4408251568"],"related_works":["https://openalex.org/W4406067984","https://openalex.org/W2946502500","https://openalex.org/W6962895265","https://openalex.org/W4413234831","https://openalex.org/W4416209094","https://openalex.org/W3013833120","https://openalex.org/W7203545014","https://openalex.org/W3005773613","https://openalex.org/W3214336044","https://openalex.org/W3209000271"],"abstract_inverted_index":{"BACKGROUND:":[0],"Orthopaedic":[1],"surgery":[2,235,262],"remains":[3,128],"one":[4],"of":[5,18,36],"the":[6,33,59,163,255,272,319],"least":[7],"gender-diverse":[8],"medical":[9,26],"specialties,":[10],"with":[11],"women":[12],"making":[13],"up":[14],"a":[15,129,236],"small":[16],"fraction":[17],"practicing":[19],"surgeons":[20],"despite":[21],"increasing":[22],"female":[23,37,63,143,182,252,280,303],"enrolment":[24],"in":[25,72,113,184,254,260,309,318],"schools.":[27],"The":[28],"\"leaky":[29],"pipeline\"":[30],"phenomenon":[31],"describes":[32],"progressive":[34],"loss":[35],"trainees":[38,79,144,183,304],"due":[39,264],"to":[40,62,92,145,154,161,197,204,250,265,277,290],"systemic":[41,151,267],"barriers":[42,152,313],"such":[43,224],"as":[44,132,225],"implicit":[45],"bias,":[46],"workplace":[47,99,297],"discrimination,":[48,104],"inequitable":[49],"surgical":[50,114],"training":[51,134,200,210,293],"opportunities,":[52,294],"and":[53,94,96,106,120,136,158,177,188,211,228,285,295,305,325],"inadequate":[54],"work-life":[55],"balance":[56,127],"policies.":[57],"Understanding":[58],"factors":[60],"contributing":[61],"trainee":[64],"attrition":[65,156],"is":[66,299,321],"essential":[67,300],"for":[68,214,241,301],"fostering":[69],"gender":[70,307],"equity":[71,308],"orthopaedic":[73,78,164,234,261],"surgery.":[74],"MAIN":[75],"BODY:":[76],"Female":[77],"face":[80],"unique":[81],"challenges,":[82],"including":[83],"stereotypes":[84],"that":[85,316],"question":[86],"their":[87,147],"physical":[88],"capability,":[89],"limited":[90],"access":[91],"mentorship":[93,176],"sponsorship,":[95],"an":[97],"unsupportive":[98],"culture.":[100],"Many":[101],"report":[102],"experiencing":[103],"microaggressions,":[105],"exclusion":[107],"from":[108],"leadership":[109,186],"pathways.":[110],"Additionally,":[111,220],"disparities":[112,259],"case":[115,192],"assignments":[116],"limit":[117],"skill":[118,324],"development":[119],"career":[121,148,239],"advancement,":[122],"further":[123],"discouraging":[124],"retention.":[125,219],"Work-life":[126],"major":[130],"concern,":[131],"rigid":[133],"schedules":[135],"insufficient":[137],"parental":[138,230],"leave":[139],"policies":[140,194,213,298],"force":[141],"many":[142],"reconsider":[146],"paths.":[149],"These":[150],"contribute":[153],"higher":[155],"rates":[157],"hinder":[159],"efforts":[160],"diversify":[162],"workforce.":[165],"To":[166],"address":[167],"these":[168,312],"issues,":[169],"institutions":[170],"must":[171],"implement":[172],"targeted":[173,270],"reforms.":[174],"Formal":[175],"sponsorship":[178],"programs":[179],"can":[180,216,232],"support":[181],"securing":[185],"roles":[187],"competitive":[189],"fellowships.":[190],"Equitable":[191],"distribution":[193],"are":[195],"necessary":[196],"ensure":[198,315],"fair":[199],"opportunities.":[201],"Institutional":[202,288],"commitment":[203,289],"creating":[205],"inclusive":[206],"environments":[207],"through":[208],"bias":[209],"zero-tolerance":[212],"discrimination":[215],"help":[217],"improve":[218],"introducing":[221],"family-friendly":[222],"policies,":[223],"flexible":[226],"scheduling":[227],"structured":[229],"leave,":[231],"make":[233],"more":[237],"viable":[238],"choice":[240],"women.":[242],"Early":[243],"outreach":[244],"initiatives":[245],"should":[246],"also":[247],"be":[248],"expanded":[249],"encourage":[251],"interest":[253],"specialty.":[256],"CONCLUSION:":[257],"Gender":[258],"persist":[263],"longstanding":[266],"challenges.":[268],"Without":[269],"interventions,":[271],"leaky":[273],"pipeline":[274],"will":[275,314],"continue":[276],"exclude":[278],"talented":[279],"surgeons,":[281],"limiting":[282],"diversity,":[283],"innovation,":[284],"patient":[286],"care.":[287],"mentorship,":[291],"equitable":[292],"supportive":[296],"retaining":[302],"achieving":[306],"orthopaedics.":[310],"Addressing":[311],"success":[317],"field":[320],"determined":[322],"by":[323],"dedication":[326],"rather":[327],"than":[328],"gender.":[329]},"counts_by_year":[{"year":2026,"cited_by_count":3},{"year":2025,"cited_by_count":1}],"updated_date":"2026-11-12T12:28:57.059296","created_date":"2025-10-10T00:00:00"}