Women surgeons were more often perceived as targets of workplace gender discrimination than men surgeons in a questionnaire study of a surgical association in the Anglophone Caribbean, despite no reported gender-based differences in perceived clinical judgment or surgical skill.

The findings, published in The Permanente Journal, were consistent with the researchers’ hypothesis that implicit gender bias may contribute to workplace discrimination in surgical settings. However, the study did not directly measure implicit bias and could not establish causality.

Researchers surveyed members of a professional surgical association between September 1 and November 30, 2025, using a 28-item electronic questionnaire designed to assess perceptions of gender discrimination and four proxy measures of clinical competence: clinical judgment, thoroughness, surgical skill, and task completion.

Of the 140 questionnaires distributed, 95 responses indicated observed workplace gender discrimination. The study did not report the total membership of the association, making the representativeness of respondents unclear. Among respondents who observed discrimination, 64% reported discrimination against surgeons who were women compared with 4% who reported discrimination against surgeons who were men.

Respondents reported no statistically significant gender-based differences in clinical judgment or surgical skill. However, women surgeons were perceived as performing better in thoroughness by 47% of respondents compared with 2% who favored men surgeons. Women surgeons were also perceived as performing better in task completion by 60% of respondents compared with 24% who favored men surgeons.

In subgroup analyses, residents in training programs were more likely than preprogram respondents to perceive gender-based differences in thoroughness, with the perceived difference favoring women surgeons. By contrast, perceptions regarding task completion did not differ significantly according to respondent gender, seniority, generation, years since medical school graduation, or training level, despite the statistically significant finding observed in the overall cohort.

The researchers reported finding no demonstrable difference in clinical acumen or performance between genders and suggested the findings were consistent with implicit bias as a contributing factor to workplace discrimination. However, the study design could only support that interpretation indirectly by failing to identify measurable performance differences; it could not directly identify implicit bias as the mechanism underlying discrimination.

The findings align with prior outcomes research discussed by the researchers. In one cited population-based cohort study involving more than 1 million patients, postoperative complications and mortality were lower among patients treated by women surgeons compared with men surgeons.

The researchers acknowledged several limitations, including the survey-based design, reliance on subjective perceptions rather than objective clinical or patient outcomes, and the absence of validated implicit-bias assessment tools such as the Implicit Association Test. The respondent pool also included more men than women at an approximately 1.6:1 ratio, which may have influenced findings. Additional limitations included the lack of data on nationality, ethnicity, practice environment, and level of experience, as well as the exclusion of anesthesiologists, nurses, and other members of the health care team. The study population was limited to surgeons from a single regional professional association, potentially limiting generalizability outside the Anglophone Caribbean.

“The surgical community must address this with urgency, because impeding full participation by women creates the chance for undermining the expansion of the workforce needed for the next generations’ surgical care,” wrote lead study author Shamir O Cawich, MD, of Port of Spain General Hospital in Trinidad and Tobago, and colleagues.

Disclosures: The researchers reported no conflicts of interest and no external funding.

Source: The Permanente Journal