Finding Mentorship for the Skull Base Trainee

Background More than half of medical students are women, but gender disparities continue to exist in neurosurgical and otolaryngology residency programs. This difference is more pronounced in neurosurgery, where women have lower entry rates and higher attrition rates compared with males (17 vs. 5.3%). A lack of role models and mentorship has been identified as barriers to success by female trainees in academic medicine. Some studies suggest that female trainees may benefit from female role models and/or mentors, while others contend that gender is irrelevant. Skull base pathology requires an interdisciplinary approach usually requiring input from neuroradiologists, otolaryngologists, radiation oncologists, ophthalmologist, oncologists, and neurosurgeons. Given the involvement of specialties with higher rates of female participation, we hypothesized that gender differences observed in neurosurgery would be less pronounced in the interdisciplinary skull base field.

Methods A cross-sectional analysis was performed to identify the rates of female involvement at various career stages from applying to residency to chairing an academic program.

Results From 2012 to 2016, 19% of applicants per year to neurosurgical residency programs were female; 31% of applicants per year for otolaryngology. Currently there are nine neurosurgery programs with none female residents (2.9% of programs). The leadership of neurosurgery residency programs is mainly male—three female department chairs (2 interim; 2.8%) and seven female program directors (6.5%). Editorial boards of neurosurgery journals contain few women (JNS 0% female, JNS: Spine 0%, JNS: Pediatrics 17%, combined 5.7% female), with higher rates of women in otolaryngology (JAMA-Otolaryngology 25%, Otolaryngology-Head and Neck Surgery 35%, Laryngoscope 19.6%, combined 24%). The Journal of Neurological Surgery Part B Skull Base has 8.3% females on the editorial board. Fellowship directors are largely male with only one female listed as a codirector of a neurosurgery fellowship while ENT has two females listed. The North American Skull Base Society (NASBS) annual meeting has female participation on the Scientific Program Committee, but sparse female representation on the Executive Committee, Directors at Large, and Board of Advisors (1 female in any of these roles over 2 years compared with 41 males). In 2016, women composed 9.6% of faculty and in 2017, 15.5% were female. Although female participation is increasing at multiple levels, the ranks of the “master surgeons” who speak at the NASBS national meeting are almost all male (1 female, 60 males with 2016 and 2017 participants combined).

Conclusion As compared with otolaryngology, neurosurgery has fewer females applying to residency, completing training, acting in leadership positions, and participating on editorial boards. More women are entering these fields than in the past and as this generation of surgeons finishes training, we will likely see an increase in female leadership. For women currently in training, an interdisciplinary field such as skull base surgery with comparatively higher rates of female participation, particularly at national meetings, provides trainees with networking opportunities and the identification of female mentors/role models even if they are of a different specialty.