Individual Strategies and Institutional Solutions: Advancement of Asian Women in Academic Surgery

Asian women remain underrepresented in academic surgical leadership, despite increasing diversity among trainees and junior faculty over recent decades. While prior work has identified structural and cultural barriers to advancement, less is known about how individuals navigate these barriers and what solutions are necessary to promote retention and career progression. This qualitative study explores Asian women surgeons' perspectives on actionable strategies to promote retention and advancement.

Semi-structured interviews were conducted with Asian women surgeons recruited via a national surgical society. Transcripts were analyzed using grounded theory to identify participant-reported strategies to navigate barriers and institutional and systemic solutions identified as necessary for meaningful change.

Twenty Asian women surgeons participated: 60% were academic faculty, 10% were faculty who had transitioned to private practice and 30% were trainees; 65% graduated from an American medical school. Participants described individual strategies including behavioral modification, self-promotion, proactive pursuit of mentorship and sponsorship, cultivating diverse mentorship and peer support networks, and perseverance within an inequitable system. Institutional solutions described included transparent and inclusive promotion pathways, equity-oriented policies, infrastructure and resource distribution, proactive and accountable leadership, increasing diversity beyond demographic representation, addressing racism and sexism and broader institutional initiatives like targeted support for mid-career faculty, and structured mentorship and sponsorship programs.

While Asian women employ a range of individual strategies to advance in academic surgery, lasting progress requires institutional and structural change to reduce subjectivity in advancement, equitably distribute resources and opportunities, and hold leadership accountable for creating inclusive, supportive academic environments.