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The risks of radiation exposure in orthopaedic surgery have become a topic of increasing interest in the setting of widespread fluoroscopy use and concern for an increased prevalence of breast cancer among female orthopaedic surgeons. The aim of this national study of 31 female orthopaedic surgeons was to achieve a deeper understanding of fluoroscopic use in the OR and its associated exposure to radiation, by comparing female orthopaedic trauma and arthroplasty surgeons.
A total of 31 surgeons wore dosimeters for 10 operating days each to track cumulative radiation exposure. Surgeons were not asked to modify their practice in any way, with no requirement that the operating days had to be chosen with the knowledge that fluoroscopy would be used. Participants were also asked to fill out a form at the end of each day, detailing the number of cases that day, the number of hours spent in the OR, and the total amount of time using fluoroscopy.
Trauma surgeons received significantly higher radiation doses in the OR (p=0.01) and reported longer use of fluoroscopy (p<0.001). Trauma surgeons also spent more time per day in the OR and had more cases per day compared to arthroplasty surgeons, but this difference was not significant. Radiation dose penetrating through protective equipment remained minimal.
Although the female trauma surgeons in the study operated longer and performed more procedures per day, the higher radiation exposure was best explained by the amount of time fluoroscopy is used in the OR. The fluoroscopic times in this study therefore may be a useful self-assessment tool for attending trauma and arthroplasty surgeons. Awareness of these differences will hopefully increase an individual surgeon\'s mindfulness toward the length of fluoroscopy use in each case, regardless of orthopaedic subspecialty.Level of Evidence: IV.

OBJECTIVE: Bias has been shown to influence the experience and mental health of healthcare professional trainees and faculty in academic medicine. The authors investigated the character and impact of self-reported bias experiences sustained in the academic medical arena that were submitted anonymously online to the website SystemicDisease.com.
METHODS: This qualitative study analyzed 22 narratives submitted online to SystemicDisease.com between September 2015 and March 2017. Both deductive and inductive content analysis was performed, using a combination of a priori axial and open coding.
RESULTS: The most commonly reported biases occurred on the basis of race and/or gender. Multiple submitters indicated this bias had influenced or threatened their intended career trajectory. Healthcare professional trainees also expressed altruistic concerns toward other underrepresented individuals as well as toward patients from disadvantaged backgrounds.
CONCLUSIONS: Racial and gender bias constitute a considerable barrier for trainees and professionals in academic medicine. Institutional awareness of these impacts can inform interventions designed to foster a more inclusive professional climate.

This contribution is focused on analysing the power of \'masculinization\' through which traditional humanitarian storytelling has been shaped. Strongly marked by a patriarchal vision, humanitarian accounts have traditionally hidden the work of women while stressing that performed by men, who appeared represented as true protagonists and, even, as heroes. In particular, this article analyses the professional career of a Spanish female surgeon named María Gómez (1914-1975) between 1944 and 1950, when she worked in a small charitable hospital based in Toulouse (France) for improving the health-care conditions of Spanish Republican refugees. Known as Hospital Varsovia or as Walter B. Cannon Memorial Hospital in the United States, it was supported by several humanitarian agencies, such as the Unitarian Service Committee (USC) and the Joint Anti-Fascist Refugee Committee (JAFRC). In order to get funds, both entities filmed a propaganda documentary in 1946, Spain in Exile, which deliberately ignored Gómez\'s work as a surgeon in this hospital. By examining this visual record, this article attempts to reconstruct the life and the professional career of this female physician, which was at the crossroads of the Spanish Civil War, the Second World War and the ideological polarization emerging in the Cold War period.

Underrepresentation of female authors in research publications is prevalent, but it is unclear whether this is attributable to sex disparities in research conduct or authorship practices. Case reports are a poorly understood component of the biomedical corpus, and the production of anecdotal observations is not confounded by factors associated with disparities in female representation in research publications. Whether female authorship disparities exist in nonresearch publications of clinical information is unknown.
To examine the authorship of case reports and elucidate factors associated with sex disparity.
Cross-sectional study of all case reports published by US authors in 2014 and 2015 indexed in PubMed performed from July 2015 to July 2018.
The primary outcome measure was the proportion of female first authors. The secondary outcome measures were the proportion of female last authors and female authorship representation among different clinical specialties.
Bibliometric data was abstracted from 20 427 case reports published across 2538 journals. A total of 7252 (36%) and 4825 (25%) case reports had a female first and last author, respectively. In comparison, 44% and 34% of US trainees and physicians, respectively, were female in 2015. Among adult case reports, female authorship was more prevalent in academic environments compared with community settings (34.0% vs 28.2% for female first authors and 23.4% vs 19.7% for female last authors). Across states, the proportions of female first authors and last authors were universally less than the proportions of female trainees and active female physicians, respectively. Female first authorship was associated with larger author teams (odds ratio [OR], 1.02; 95% CI, 1.01-1.03), an academic affiliation (OR, 1.16; 95% CI, 1.06-1.27), and a female last author (OR, 1.58; 95% CI, 1.47-1.70). Relative to general internal medicine, specialties dominated by male clinicians were less frequently associated with female first authors. Several exceptions displaying a relatively equivalent tendency for male and female first authorship included oncology (OR, 0.97; 95% CI, 0.81-1.16), ophthalmology (OR, 0.87; 95% CI, 0.72-1.05), and radiation oncology (OR, 0.94 95% CI, 0.56-1.56).
The underrepresentation of women among first and last authors in publications of case reports underscores the pervasiveness of sex disparities in medicine. Collaboration and female mentors may be critical instruments in upsetting longstanding practices associated with sex bias. Not all clinical specialties were associated with lower-than-expected female authorship, and further exploration of specialty-specific norms in publication and mentorship may elucidate specific barriers to female authorship.

Data regarding gender disparities in surgeon case volumes across subspecialties is sparse.
Through the use of the New York SPARCS database, top 25 yearly performers of major surgical procedures were identified for each year from 2000 to 2014. Gender and academic affiliation was determined.
Breast surgery had the highest number (51.6%) of female top performers by surgical volume. Higher number of female surgeons in bariatric and breast surgery were associated with academic institutions (p < 0.001). Significantly higher number of female plastic surgeons were associated with community institutions (p = 0.02). While there was an increase in female top performers during the study period, the number of female top performing surgeons remained disproportionately low compared to male top performing surgeons. There were no female surgeons among the top performers in vascular, orthopedics, cardiac, and urology during the studied period.
There is a gender disparity in surgeon case volumes. While some subspecialties showed some increase in female top performers, the majority remained male-dominated fields during the fifteen-year period.

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