Woman or surgeon - Not both: Perceptions of support, enablers and barriers in general surgery.

Introduction: The General Surgery (GS) educational community of practice faces crisis. Recruitment is challenged by cultural norms of postponing post-foundation training; and retention with perceptions of elitism, discrimination and inflexibility (UK Shape of Training Steering Group, 2017; Kennedy, 2021) [1,45]. Surgical pedagogy has been examined through skill acquisition but what of the hidden curriculum (Brown et al., 2019) [26]. Three research aims were posed: who is a General Surgeon, what are the enablers or barriers to pursuing this career and is our current UK training system fit for purpose. Methods: Qualitative methodology within a constructivist research paradigm was utilised. Recruitment included representative sampling of junior doctors, including men, women and those from diverse ethnic backgrounds. Individual semi-structured interviews explored participant perspectives of training, recruitment and work-life balance. Data was transcribed, familiarised, de-constructed and generated. Latent data analysis, coding and development, maintained reflexivity. 'Data sets' were transformed to a thematic map and key themes identified. Results and discussion: Foundation, specialty doctors, core and higher surgical trainees were included (60 % men, 40 % women). Fundamental themes of support, attitudes and sacrifice were identified, interacting to influence educational narrative. Support comprised personal, institutional, academic and cultural forms. Attitudes of elitism, implicit and explicit gender bias, microaggressions and overt discrimination concealed as surgical tradition. An overarching concept of sacrifice was noted: personal, professional, fiscal and emotional, the so-called surgical currency. Conclusions: The study explored phenotype, motivation, intellect and philosophy within GS. Highlighting issues in the system surrounding negative attitudes, cultures and behaviours, education is a powerful tool which can be used to challenge perceptions and improve training.