The “leaky pipeline” concept in surgery refers to the phenomenon of losing capable individuals at various stages of surgical training due to systemic structural barriers and workplace culture. Despite growing numbers of women entering medical schools, the pipeline to surgical leadership remains predominantly male-dominated. Sexual harassment, bullying, and discrimination against women are pervasive, making it difficult for female surgeons to thrive. Moreover, surgical training is notoriously inflexible, with long working hours and high demands on personal time, disproportionately affecting women. In response, Women in Surgery network and the Women in ENT group have been established to provide mentorship opportunities, access to networking events and educational resources, and create a more inclusive and equitable workplace culture. The Royal College of Surgeons of England has commissioned the Kennedy report on diversity in surgery, which includes recommendations addressing the attrition of women in surgery. These initiatives have led to a rise in female ENT surgeons over the last decade, with an increase in female ENT surgical trainees from 32% to approximately 48%, and growth among women serving as ENT consultants, increasing from 10% to 18%. While the progress made by these initiatives towards increasing gender diversity in surgery is commendable, progress has been slow, and more comprehensive and multifaceted approaches are needed. The article argues that active participation of all stakeholders, including the Colleges, organizations responsible for surgical training, and surgeons is required to change this culture and fix the leaky pipeline.

Introduction The UK Medical Licensing Assessment (UKMLA) curriculum represents a consensus on core content including ENT-related content for newly qualified doctors. However, there is no similar consensus as to how ENT content should be taught at medical school. Design A virtual consensus forum was held at the 2nd East of England ENT Conference in April 2021 to ascertain views of medical students and junior doctors on how ENT should be taught at medical school. A syllabus of ENT-related items based on the UKMLA and GMC practical procedures curricula was divided into ‘Presentations’, ‘Conditions’ and ‘Practical Procedures’. 64 participants (27 students, 11 foundation doctors, and 7 other junior doctors) voted via anonymous polling for up to three of nine teaching methods they believed were best suited to teach each syllabus item. Results For ‘Presentations’, work-based/clinical-based learning and small-group seminars were significantly more popular than other methods, a further two were of middling popularity, and the remaining five (including simulation and e-learning) were significantly less popular. ‘Conditions’ results were near-identical, with work-based/clinical-based learning and small-group seminars significantly more popular than the remaining teaching methods. For ‘Practical procedures’ the three practical teaching methods were significantly more popular than the six theoretical methods. Conclusion Students and junior doctors express clear preference for clinical-based teaching and small-group seminars when learning ENT content. E-learning is poorly favoured, despite being increasingly used by medical schools and teaching bodies. Co-design of clinical training between students and educators may ensure training better matches students’ needs and expectations.