Background: This study aimed to evaluate gender inequality within the Surgical Education and
Training (SET) programmer selection process to identify barriers to gender equality and to outline
solutions to bridge this divide.
Methods: A systematic review was conducted using Medical Subject Headings, Emtree terms,
subject headings, and key terms. Quality assessments were performed using the Critical Appraisal
Skills Program Qualitative Checklist and the Joanna Briggs Institute Critical Appraisal Checklist.
Since some studies included quantitative and qualitative data, we used the Mixed Methods Appraisal
Tool to assess this subcategory of papers.
Results: The literature search produced 191 citations: 81 in PubMed, 23 in EMBASE, 40 in ERIC, 16
in PsycINFO, and 31 in Medline. The records identified through other sources (e.g., grey literature,
cross-referencing, and Royal Australasian College of Surgeons abstracts) produced 35 additional
citations. The full texts of a total of 156 non-duplicated potential articles were obtained for closer
inspection, of which 13 were included in the final analysis. Lack of female leadership and surgical
role models, passive bullying and gender discrimination, lack of positive mentorship and flexible
surgical training programs were identified as potential barriers to gender equality in surgical
Conclusion: Despite more females entering the medical profession, obvious gender imbalances
persist across all surgical training fields. Gender inequality continues to exist amongst trainees.
There is a paucity of publications addressing this topic and a prevailing inclination among females
to make alternative career choices despite best efforts to make surgical training more appealing.