Research Protocol

Authors:

Soham Bandyopadhyay, BA (Hons)¹

Jigishaa Moudgil-Joshi, BMedSci (Hons)²

Emma Jane Norton, BSc (Hons)³

Makinah Haq MBBS (Candidate)⁴

¹Medical Sciences Division, University of Oxford, Oxford, OX3 9DU

²The University of Edinburgh, 47 Little France Crescent, Edinburgh, EH16 4TJ

³St George’s, University of London, Cranmer Terrace, London, SW17 0RE

⁴GKT School of Medical Education, King’s College London, London, WC2R 2LS

Corresponding author:

Soham Bandyopadhyay

+447534264921

nansiggroup@gmail.com

Background

The Ottawa 2010 consensus declared that surgical specialties should produce a workforce broadly representative of the population they serve without compromising on the quality of the workforce¹. Since then, the proportion of female NHS doctors has grown year on year. However, despite a narrowing of the gender gap, surgery continues to be predominantly male². This is most evident in neurosurgery, trauma and orthopaedic surgery (T&O), and cardio-thoracic surgery, where only around 18% of the surgeons are female. Notably, the proportion of women in the latter two disciplines has increased in line with the majority of other medical specialities. This trend was not seen in neurosurgery².Whilst there are significant barriers to the advancement of women in surgical careers³, the increasing use of social media for professional purposes⁴ could aid and benefit women passionate about neurosurgery to address some of the challenges that they face.

Previous attempts to attract women into surgery have been confounded by insufficient understanding of how best to approach this⁵. Research in this area typically involves using quantitative methods to investigate barriers women have faced in surgery. These methods have resulted in a list of contributory factors to women not entering or choosing to leave neurosurgery, such as insufficient role models, inflexible work environments, gender discrimination and harassment, sleep deprivation, and family responsibilities^6,7. Whilst these methods have been excellent at describing the challenges faced by women in surgery, it has not been able to explain how to counter these challenges. Additionally, quantitative studies are not able to investigate phenomena that are not described in their fixed-choice surveys. Qualitative studies do not need to suffer from these limitations⁸. The richness of language paired with the researchers’ openness to paradoxical findings can answer problems in previously unthought of ways⁹. In addition, qualitative research is less likely to lead to assumptions as it does not rely on the use of measurement instruments that may be tacitly biased¹⁰.

This study will be qualitative in nature. It will focus on individuals’ expectations which are highly subjective and based on personal priorities¹¹. Women interested in neurosurgery or currently practicing neurosurgery will be interviewed. The questions will be focussed around why they want to do neurosurgery/ are doing neurosurgery, perceived barriers, and the role social media can play. We will take a participatory qualitative approach¹², where research subjects will be actively involved in the research process and the co-creation of understandings and potential solutions. All interviews will be recorded and reduced via manifest level coding to identify themes.

We aim to assess how social media could be used to incentivise women to apply to and remain within neurosurgery.

Methods

Design

Qualitative approach will be employed to obtain the necessary data. Participants will be sent information about this project and asked for their consent to proceed. Interviews will only be conducted if participants have provided informed consent, including permission to record and transcribe the conversations. Collected data will be 1. recorded during the interviews, 2. Transcribed, 3. Analysed, 4. Labelled and coded, 5. Codes will be reduced to themes. Following the generation of themes, participants will be invited to check their own extracts related to each theme and delete portions if desired.

Inclusion and Exclusion Criteria

Inclusion: Women who are practicing neurosurgeons or want to become neurosurgeons.

Exclusion: Cannot speak English or Unable to attend interview

Data Collection

Data is collected through one on one interviews in person or by telephone. These interviews will be semi structured with a few pre-determined question prompts to guide the interviewee if need be. Leading questions will be avoided. Depending on emerging themes, these questions will be changed and altered. The semi structured interviews suit the study well and will follow the advice of Whiting in 2008¹³.

Information Governance

The study will result in the following data sources: 

• Recordings of interviews
• Transcripts of the above

These data sources will be stored in accordance to Good clinical practise and the Data Protection Act 1998

Funding

This study is not funded.

Execution

Analysis Plan

Transcribing and coding will be done manually. Data will be reduced via manifest level coding to identify themes. Sub-group analysis depending on the stage of training of the women may be done.

Dissemination

The survey findings will be disseminated in national and international conferences, and peer-reviewed publications.

References 

1. Prideaux D, Roberts C, Eva K, et al. Assessment for selection for the health care professions and specialty training: Consensus statement and recommendations from the Ottawa 2010 Conference. Medical Teacher. 2011;33:215-223. Available from: doi:10.3109/0142159X.2011.551560

• NHS Digital. Narrowing of NHS gender divide but men still the majority in senior roles. Available from https://digital.nhs.uk/news-and-events/latest-news/narrowing-of-nhs-gender-divide-but-men-still-the-majority-in-senior-roles [Accessed 25th February 2020].

• Abosch A, Rutka JT. Women in neurosurgery: inequality redux. J Neurosurg. 2018 Aug 1;129(2):277–81.

• Guraya SY. The usage of social networking sites by medical students for educational purposes: A meta–analysis and systematic review. Vol. 8, North American Journal of Medical Sciences. North American Journal of Medical Sciences; 2016. p. 268–78.

• Walsh U, Meyer FJ. Awareness and impact of WINS on female surgical trainees. Ann R Coll Surg Engl. 2011; 93: 1E-5E.

• Venes J. Women in neurological surgery. J Neurosurg (4 Suppl Pediatrics). 2006; 104:227-232

• Woodrow SJ, Gilmer-Hill H, Rutka JT. The neurosurgical workforce in North America: a critical review of gender issues. Neurosurgery. 2006; 59: 749 – 758.

• Regehr G. It’s NOT rocket science: rethinking our metaphors for research in health professions education. Med Ed. 2010; 44: 31-39.

• Malterud K. The art and science of clinical knowledge: evidence beyond measures and numbers. Lancet. 2001; 358: 397-400.

1. Denzin NK, Lincoln YS. The SAGE handbook of qualitative research. 5^th edn. SAGE publishing, Thousand Oaks; 2017 p. 151-194.

1. Hammarberg K, Kirkman M, de Lacey S. Qualitative research methods: when to use them and how to judge them. Human Reproduction, Volume 31, Issue 3, March 2016, Pages 498–501, 

1. Maguire P. Doing participatory research: a feminist approach. Centre for International Education, Amherst, MA1987:305.

1. Whiting LS. Semi-structured interviews: Guidance for novice researchers. Nursing standard. 2008; 22(23), pp.35-40