Examining Gender Diversity in Neurosurgery Residency Programs: The Role of Leadership, Geography, and Subspecialization Trends

Introduction: To inform neurosurgery residency programs looking to increase gender diversity, the purpose of this study was to describe the relationship between the percentage of female residents and the following factors: gender diversity of leadership, geographical factors, and subspecialty.

Methods: Gender data on residents was manually collected from neurosurgery program websites by cross-referencing pronoun usage of residents, which was validated with gender data from Association of American Medical Colleges and American Medical Association (AMA). Gender of chairs and program directors was collected in the same manner. Percentage of female attendings and cost of living data were extrapolated from AMA. Percentage of alumni sub-specializing and fellowships offered were compiled from Doximity and Society of Neurological Surgeons. Regional information was extracted from Census data. Data analysis was conducted via R (version 4.4.1, www.r-project.org).

Results: University of Washington (12) had the highest number of women residents whereas University of Massachusetts (83%) had the highest percentage. The mean percentage of women residents across programs was 27% (median = 26%). The percentage of women residents did not differ based on the percentage of female faculty (p=0.59) nor the gender of either the chairs (p=0.17) or program directors (p=0.31). There were no significant differences in percentage of women residents between regions (p=0.35) or cost of living (p=0.93). There was a significant correlation between the percentage of women residents and the overall percentage of alumni that subspecialized (p=0.04), but not for the percentage of alumni subspecializing in each subspeciality or the number of fellowships a program offered.

Conclusion : Female residents were not associated with leadership gender, geographical factors, alumni pursuing individual subspecialties, or fellowship programs, but were associated with overall alumni sub-specialization. Though the relationship is not clear, programs with female residents may foster more opportunities for individuals to pursue diverse subspecialties or female residents may be more inclined to subspecialize.