• Alexandra B Columbus, Pamela W Lu, Susanna S Hill, Adam C Fields, Jennifer S Davids, and Nelya Melnitchouk.
• Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts.
• JAMA Surg. 2020 Nov 1; 155 (11): 1028-1033.

ImportanceOnly 7% of US surgical department chairs are occupied by women. While the proportion of women in the surgical workforce continues to increase, women remain significantly underrepresented across leadership roles within surgery.ObjectiveTo identify commonality among female surgical chairs with attention toward moderators that appear to have contributed to their professional success.Design, Setting, And ParticipantsA grounded theory qualitative study was conducted in academic surgical departments within the US. Participants included current and emeritus female chairs of American academic surgical departments. The study was conducted between December 1, 2018, and March 31, 2019. An eligible cohort of 26 women was identified.Interventions And ExposuresParticipants completed semistructured telephone interviews conducted with an interview guide.Main Outcomes And MeasuresCommon themes associated with career success.ResultsOf the eligible cohort of 26 women, 20 individuals (77%) participated. Sixteen participants were serving as active department chairs and 4 were former department chairs. Mean (SD) length of time served in the chair position, either active or former, was calculated at 5.6 (2.6) years. Two major themes were identified. First, internal factors emerged prominently. Personality traits, including confidence, resilience, and selflessness, were shared among participants. Adaptability was described as a major facilitator to career success. Second, participants described 2 subtypes of external factors, overt and subtle, each of which included barriers and bolsters to career development. Overt support from mentors of both sexes was described as contributing to success. Subtle factors, such as gender norms, on institutional and cultural levels, affected behavior by creating environments that supported or detracted from career advancement.Conclusions And RelevanceIn this study, participants described both internal and external factors that have been associated with their advancement into leadership roles. Future attention toward encouraging intrinsic strengths, fostering environments that bolster career development, and emphasizing adaptability, along with work-system redesign, may be key components to career success and advancing diversity in surgical leadership roles.

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