title: Factors that Can Promote or Impede the Advancement of Women as Leaders in Surgery: Results from an International Survey.
abstract: BACKGROUND
  Compared with male surgeons, women have less success advancing their careers and are underrepresented in leadership positions in surgery. The purpose of this study is to identify the qualifications necessary to become leaders in surgery and the career barriers faced by women surgeons in various cultural environments.
  
  
  METHODS
  A survey was performed with women surgeons in Japan, USA, Finland, and Hong Kong, China, to assess various barriers faced by women surgeons in the respective countries. To develop appropriate survey tool, a preliminary questionnaire was distributed to leaders in surgery and also in various organizations worldwide.
  
  
  RESULTS
  The response rate was 23 % with 225 of 964 survey returned. Japanese women surgeons identify lacked family support as impeding a successful surgical career. US women surgeons feel more latent gender discrimination. Finnish women surgeons are less likely to need to sacrifice work-life balance, when holding leadership positions. Women surgeons worldwide are highly motivated to develop their career and agree the percentage of women surgeons in leadership positions should be increased.
  
  
  CONCLUSIONS
  Women surgeons in different countries perceive different challenges. We must develop strategies and should not hesitate to negotiate to overcome these issues to reach leadership positions in surgery. This may be accomplished through networking worldwide to improve current conditions and obstacles.
authors.affiliation: Department of Surgery, The Jikei University School of Medicine, Tokyo, Japan. kawasekazumi@hotmail.com.
authors.forename: Kazumi
authors.initials: K
authors.lastname: Kawase
authors.affiliation: Department of Surgery, Helsinki University Central Hospital, Helsinki, Finland.
authors.forename: Monika
authors.initials: M
authors.lastname: Carpelan-Holmström
authors.affiliation: Division of Breast Surgery, Queen Mary Hospital, The University of Hong Kong, Hong Kong SAR, China.
authors.forename: Ava
authors.initials: A
authors.lastname: Kwong
authors.affiliation: Department of Surgery, SIU School of Medicine, Illinois, USA.
authors.forename: Hilary
authors.initials: H
authors.lastname: Sanfey
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D002322:Career Mobility; D002681:China; D005260:Female; D005387:Finland; D006801:Humans; D007564:Japan; D007857:Leadership; D008297:Male; D009042:Motivation; D010822:Physicians, Women / Q000523:psychology*; D063507:Sexism; D066231:Surgeons / Q000523:psychology*; D011795:Surveys and Questionnaires; D014481:United States