Abstract
BACKGROUND: Despite increasing gender diversity in medicine, orthopedic surgery remains male-dominated, especially in India. This study aimed to explore male orthopedic surgeons' perspectives on the competence of female colleagues, their intraoperative preferences, and training experiences. MATERIALS AND METHODS: A cross-sectional survey was conducted among 226 male orthopedic surgeons in India. Data on age, years of experience, type of practice, and training history were collected. Respondents shared their perceptions regarding gender-based competence, surgical assistance preferences, and challenges in training women. Statistical analysis (chi-square and t tests) was performed to assess associations between demographic variables, perceptions, and preferences. RESULTS: Most respondents worked in the private sector (69.9%), with 55.4% having 11-30 years of experience. Only 9.7% had trained more than five female residents, and 33.6% had trained none. While 74.9% believed men and women were equally competent, 34.5% preferred male assistants intraoperatively. Surgeons with >30 years of experience were significantly more likely to perceive women as competent (χ (2) = 10.88, p = 0.004), and were older (52.3 ± 10.3 years vs. 48.5 ± 10.7 years; p = 0.03). Preference for male assistants correlated significantly with fewer women trained (χ(2) = 8.11, p = 0.017) and with lower perceived competence of women (χ(2) = 58.73, p < 0.001). Word frequency analysis showed "sincerity" and "ethic" for women, and "strength" and "emergencies" for men. Key challenges in training women included perceived sensitivity to criticism and adaptation issues. CONCLUSIONS: Although gender competence is increasingly acknowledged as equal, unconscious bias persists in surgical training and assistant preferences. Promoting female mentorship and inclusive training environments is essential to address systemic disparities in orthopedics.