Background The queen bee phenomenon (QBP) describes the behavioural response that occurs when women achieve success in a male-dominated environment, and in this position of authority, treat their female subordinates more critically. It has been demonstrated in business, academia, the military, and police force. The goal of this study was to determine whether the QBP occurs in surgical specialties. We hypothesized that female surgeons, fellows, and senior surgical residents would be more critical in their assessment of junior female residents than their male counterparts. Methods A scenario-based survey was distributed via email to all Canadian surgical programs between February and March 2021. Scenarios were designed to assess either female or male learners. Centers distributed surveys to attending surgeons, surgical fellows, resident physicians, and affiliate surgeons. Respondents average Likert score for female-based and male-based questions were calculated. Subgroup analyses were performed based on gender, age, seniority, and surgical specialty. Results 716 survey responses were collected, with 387 respondents identifying as male (54%) and 321 identifying as female (45%). 385 attending surgeons (54%), 66 fellows (9%), and 263 residents (37%) responded. The mean Likert scores for female respondents assessing female learners was significantly lower than male learners (p = 0·008, CI = 95%). During subgroup analysis, some specialties demonstrated significant scoring differences. Discussion The QBP was shown to be present among surgical specialties. Female respondents assessed female learners more critically than their male counterparts. Conclusion These findings highlight the importance of tackling organizational biases to create more equitable educational and work environment in surgery.

# 01. The Queen Bee phenomenon in Canadian surgical subspecialties: an evaluation of gender biases in the resident training environment {#article-title-2} The Queen Bee phenomenon describes the behavioural response that occurs when women achieve success in a male-dominated environment, and in this

Introduction: Wait times to see an orthopaedic consultant can be lengthy. Remote communities such as Labrador City and Goose Bay, located in Labrador in the province of Newfoundland and Labrador, often do not have an orthopaedic specialist locally and patients are required to travel great distances to attend clinic appointments. The objectives of this report are to describe our Orthopaedic Outreach Programme where patients receive fracture assessments and care for musculoskeletal concerns at two local clinics by a visiting orthopaedic surgeon. We also describe the justification for the Orthopaedic Outreach Programme and list the benefits; financial and otherwise. Methods: A review of the programme, operating out of Happy Valley-Goose Bay and Labrador City, using electronic medical records, was undertaken from 1st January 2015 to 31st December 2019 including demographics and procedures completed. Travel and hotel costs were estimated. Results: Over the last 5 years, the Orthopaedic Outreach Programme treated 1,698 patients at the 2 clinics. Cost savings were estimated at $366,768 per annum. The cost savings over the last 5 years were estimated at a total of $1,833,840. This does not account for patient's time off work and lost revenue that would occur when they make the trip to St John's for a clinic appointment. Conclusions: Our Orthopaedic Outreach Programme was implemented to improve access to orthopaedic services in the remote areas of Labrador. This report aims to describe the result of a programme focused on providing orthopaedic care to individuals who would otherwise be required to travel great distances for their care.

Although Lisfranc injuries are uncommon, representing approximately 0.2% of all fractures, they are complex and can result in persistent pain, degenerative arthritis, and loss of function. Both open reduction and internal fixation (ORIF) and primary fusion have been proposed as treatment options for these injuries, but debate remains as to which approach is better.