Using Hofstede's framework to explore surgical cultures and their impact on female surgeons

Offiah, Gozie; Schofield, Susie J.; Rees, Charlotte

doi:10.1111/medu.15726

Journal article 268 views 60 downloads

Using Hofstede's framework to explore surgical cultures and their impact on female surgeons

Gozie Offiah

, Susie J. Schofield, Charlotte Rees

Medical Education, Volume: 59, Issue: 10, Pages: 1067 - 1078

Swansea University Author: Charlotte Rees

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© 2025 The Author(s). Medical Education published by Association for the Study of Medical Education and John Wiley & Sons Ltd. This is an open access article under the terms of the Creative Commons Attribution-NonCommercial License (CC BY-NC).
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DOI (Published version): 10.1111/medu.15726

Abstract

Context: Workplace diversity improves outcomes, yet surgical cultures have long been identified as a deterrent for women considering surgical careers due to male‐dominated traditions. Our study explores the impact of surgical cultures and their influence on gender through the analytical lens of Hofs...

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Published in:	Medical Education
ISSN:	0308-0110 1365-2923
Published:	Wiley 2025
Online Access:	Check full text
URI:	https://cronfa.swan.ac.uk/Record/cronfa69556

first_indexed	2025-05-22T13:08:12Z
last_indexed	2025-11-11T06:50:30Z
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spelling	2025-11-10T14:43:01.3848396 v2 69556 2025-05-22 Using Hofstede's framework to explore surgical cultures and their impact on female surgeons 909ecb28ae90d6946e0efb7cffa10dee Charlotte Rees Charlotte Rees true false 2025-05-22 MEDS Context: Workplace diversity improves outcomes, yet surgical cultures have long been identified as a deterrent for women considering surgical careers due to male‐dominated traditions. Our study explores the impact of surgical cultures and their influence on gender through the analytical lens of Hofstede's cultural dimensions framework. We apply this in a novel way to gain deeper insights into how masculinity and other cultural dimensions intersect. Methods: For this qualitative study—part of a larger study exploring gender in surgery—we conducted semi‐structured interviews with 29 female surgeons, 18 male and female colleagues of female surgeons (surgeons, anaesthetists, nurses and physician associates) and 13 patients of female surgeons. We analysed the data using framework analysis, with surgical cultures being identified as a central theme. We drew on Hofstede's cultural dimensions theory to deeply interrogate how cultural dimensions intersect to shape the surgical environment, thereby disadvantaging women. Results: Competition, achievement and heroism associated with masculinity were thought to be pervasive and hindered progression, particularly for female surgeons. Unequal power distributions were reported to lead to female surgeons working harder to earn respect. Female overseas doctors narrated the challenges of being respected by male colleagues from their own collectivist countries. Long‐standing ‘old boys’ club’ traditions associated with uncertainty avoidance were thought to maintain the gendered status quo. Long‐term orientation and restraint were reported to impact female surgeons with career breaks. However, our analysis indicated novel interplays between masculinity and the other five cultural dimensions, with some dimensions overlapping (e.g., long‐term orientation and restraint) and others contradicting (e.g., power distance and collectivist values). Conclusion: This study, drawing on Hofstede's cultural dimensions, illustrates the complexity of interacting cultural dimensions, serving to maintain inequities for female surgeons. We therefore provide recommendations for multiple interventions to enable surgical culture change, based on these intersecting six cultural dimensions. Journal Article Medical Education 59 10 1067 1078 Wiley 0308-0110 1365-2923 1 10 2025 2025-10-01 10.1111/medu.15726 COLLEGE NANME Medical School COLLEGE CODE MEDS Swansea University Another institution paid the OA fee 2025-11-10T14:43:01.3848396 2025-05-22T13:51:16.6159619 Faculty of Medicine, Health and Life Sciences Swansea University Medical School - Medicine Gozie Offiah 0000-0003-2439-6057 1 Susie J. Schofield 2 Charlotte Rees 3 69556__34330__0208d6489b14410184898142d2b6a3bd.pdf medu.15726.pdf 2025-05-22T13:51:16.5958497 Output 373707 application/pdf Version of Record true © 2025 The Author(s). Medical Education published by Association for the Study of Medical Education and John Wiley & Sons Ltd. This is an open access article under the terms of the Creative Commons Attribution-NonCommercial License (CC BY-NC). true eng http://creativecommons.org/licenses/by-nc/4.0/
title	Using Hofstede's framework to explore surgical cultures and their impact on female surgeons
spellingShingle	Using Hofstede's framework to explore surgical cultures and their impact on female surgeons Charlotte Rees
title_short	Using Hofstede's framework to explore surgical cultures and their impact on female surgeons
title_full	Using Hofstede's framework to explore surgical cultures and their impact on female surgeons
title_fullStr	Using Hofstede's framework to explore surgical cultures and their impact on female surgeons
title_full_unstemmed	Using Hofstede's framework to explore surgical cultures and their impact on female surgeons
title_sort	Using Hofstede's framework to explore surgical cultures and their impact on female surgeons
author_id_str_mv	909ecb28ae90d6946e0efb7cffa10dee
author_id_fullname_str_mv	909ecb28ae90d6946e0efb7cffa10dee_***_Charlotte Rees
author	Charlotte Rees
author2	Gozie Offiah Susie J. Schofield Charlotte Rees
format	Journal article
container_title	Medical Education
container_volume	59
container_issue	10
container_start_page	1067
publishDate	2025
institution	Swansea University
issn	0308-0110 1365-2923
doi_str_mv	10.1111/medu.15726
publisher	Wiley
college_str	Faculty of Medicine, Health and Life Sciences
hierarchytype
hierarchy_top_id	facultyofmedicinehealthandlifesciences
hierarchy_top_title	Faculty of Medicine, Health and Life Sciences
hierarchy_parent_id	facultyofmedicinehealthandlifesciences
hierarchy_parent_title	Faculty of Medicine, Health and Life Sciences
department_str	Swansea University Medical School - Medicine{{{_:::_}}}Faculty of Medicine, Health and Life Sciences{{{_:::_}}}Swansea University Medical School - Medicine
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description	Context: Workplace diversity improves outcomes, yet surgical cultures have long been identified as a deterrent for women considering surgical careers due to male‐dominated traditions. Our study explores the impact of surgical cultures and their influence on gender through the analytical lens of Hofstede's cultural dimensions framework. We apply this in a novel way to gain deeper insights into how masculinity and other cultural dimensions intersect. Methods: For this qualitative study—part of a larger study exploring gender in surgery—we conducted semi‐structured interviews with 29 female surgeons, 18 male and female colleagues of female surgeons (surgeons, anaesthetists, nurses and physician associates) and 13 patients of female surgeons. We analysed the data using framework analysis, with surgical cultures being identified as a central theme. We drew on Hofstede's cultural dimensions theory to deeply interrogate how cultural dimensions intersect to shape the surgical environment, thereby disadvantaging women. Results: Competition, achievement and heroism associated with masculinity were thought to be pervasive and hindered progression, particularly for female surgeons. Unequal power distributions were reported to lead to female surgeons working harder to earn respect. Female overseas doctors narrated the challenges of being respected by male colleagues from their own collectivist countries. Long‐standing ‘old boys’ club’ traditions associated with uncertainty avoidance were thought to maintain the gendered status quo. Long‐term orientation and restraint were reported to impact female surgeons with career breaks. However, our analysis indicated novel interplays between masculinity and the other five cultural dimensions, with some dimensions overlapping (e.g., long‐term orientation and restraint) and others contradicting (e.g., power distance and collectivist values). Conclusion: This study, drawing on Hofstede's cultural dimensions, illustrates the complexity of interacting cultural dimensions, serving to maintain inequities for female surgeons. We therefore provide recommendations for multiple interventions to enable surgical culture change, based on these intersecting six cultural dimensions.
published_date	2025-10-01T05:27:16Z
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Using Hofstede's framework to explore surgical cultures and their impact on female surgeons

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