{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T10:50:23Z","timestamp":1791888623768,"version":"4.3.4"},"reference-count":47,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2024,1,30]],"date-time":"2024-01-30T00:00:00Z","timestamp":1706572800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2024,1,30]],"date-time":"2024-01-30T00:00:00Z","timestamp":1706572800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Med Educ"],"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Background<\/jats:title>\n                <jats:p>While the number of women entering medicine has steadily increased since the 1970s in Canada, the gender composition along each stage of the medical training pathway has not been comprehensively reported. We therefore sought to systematically examine the gender composition of students, residents, and practicing physicians over the past 30 years in Canada.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>In this cross-sectional analysis of Canadian medical trainees including MD applicants (137,096 male, 169,099 female), MD students (126,422 male, 152, 967 female), MD graduates (29,413 male, 34,173 female), residents by the decade (24,425 male, 28,506 female) and practicing surgeons (total 7,457 male, 3,457 female), we find that increased female representation in medicine is not matched by representation in surgery, with the key being the specialty choice process. The likelihood of female applicants matriculating to medical school was less than male applicants in the 90s (OR 0.92, 95% CI 0.92\u20130.93), greater in the early 2000s (OR 1.03, 95% CI 1.03\u20131.04), and has since balanced out (OR 1.00, 95% CI 1.00-1.01), with medical school classes being nearly 60% female for the past two decades. Despite this, females have remained underrepresented in most surgical residency programs, with odds of female medical students entering surgical residency other than Ob\/Gyn being about half that of male students (OR 0.56, 95% CI 0.44\u20130.71), resulting in a slow increase in practicing female surgeons of less than 0.5% per year in many surgical disciplines and projected parity decades or centuries in the future.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusions<\/jats:title>\n                <jats:p>While undergraduate medical education has been majority female in Canada for nearly three decades, females remain greatly underrepresented in the physician workforce within surgical specialties. To build a representative medical workforce equipped to care for diverse patient populations, factors influencing the specialty choices of early career physicians will need to be examined and addressed.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1186\/s12909-024-05071-4","type":"journal-article","created":{"date-parts":[[2024,1,30]],"date-time":"2024-01-30T21:23:51Z","timestamp":1706649831000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":36,"title":["Gender trends in Canadian medicine and surgery: the past 30 years"],"prefix":"10.1186","volume":"24","author":[{"given":"Lauren","family":"Pickel","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nirojini","family":"Sivachandran","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2024,1,30]]},"reference":[{"key":"5071_CR1","unstructured":"Quick facts on Canada\u2019s physicians [Internet]. Canadian Medical Association. [cited 2023 Mar 10]. Available from: https:\/\/www.cma.ca\/quick-facts-canadas-physicians."},{"issue":"2","key":"5071_CR2","doi-asserted-by":"crossref","first-page":"206","DOI":"10.1001\/jamainternmed.2016.7875","volume":"177","author":"Y Tsugawa","year":"2017","unstructured":"Tsugawa Y, Jena AB, Figueroa JF, Orav EJ, Blumenthal DM, Jha AK. Comparison of Hospital Mortality and Readmission Rates for Medicare Patients Treated by male vs Female Physicians. JAMA Intern Med. 2017;177(2):206\u201313.","journal-title":"JAMA Intern Med"},{"key":"5071_CR3","doi-asserted-by":"crossref","first-page":"j4366","DOI":"10.1136\/bmj.j4366","volume":"359","author":"CJ Wallis","year":"2017","unstructured":"Wallis CJ, Ravi B, Coburn N, Nam RK, Detsky AS, Satkunasivam R. Comparison of postoperative outcomes among patients treated by male and female surgeons: a population based matched cohort study. BMJ. 2017;359:j4366.","journal-title":"BMJ"},{"issue":"3","key":"5071_CR4","doi-asserted-by":"crossref","first-page":"277","DOI":"10.1097\/MLR.0000000000000480","volume":"54","author":"S Dahrouge","year":"2016","unstructured":"Dahrouge S, Seale E, Hogg W, Russell G, Younger J, Muggah E, et al. A Comprehensive Assessment of family physician gender and quality of care: a cross-sectional analysis in Ontario, Canada. Med Care. 2016;54(3):277\u201386.","journal-title":"Med Care"},{"issue":"11","key":"5071_CR5","doi-asserted-by":"crossref","first-page":"e2027938","DOI":"10.1001\/jamanetworkopen.2020.27938","volume":"3","author":"GR Lorello","year":"2020","unstructured":"Lorello GR, Silver JK, Moineau G, McCarthy K, Flexman AM. Trends in Representation of Female Applicants and matriculants in Canadian Residency Programs Across Specialties, 1995 to 2019. JAMA Netw Open. 2020;3(11):e2027938.","journal-title":"JAMA Netw Open"},{"issue":"2","key":"5071_CR6","first-page":"E346","volume":"8","author":"SM Ruzycki","year":"2020","unstructured":"Ruzycki SM, Earp M, Ma IWY. Applicant gender and matching to first-choice discipline: a cross-sectional analysis of data from the Canadian Resident Matching Service (2013\u20132019). Can Med Association Open Access J. 2020;8(2):E346\u201351.","journal-title":"Can Med Association Open Access J"},{"key":"5071_CR7","doi-asserted-by":"crossref","unstructured":"Baerlocher MO, Detsky AS. Are applicants to Canadian residency programs rejected because of their sex? CMAJ. 2005;173(12):1439\u201340.","DOI":"10.1503\/cmaj.050739"},{"issue":"6","key":"5071_CR8","first-page":"434","volume":"50","author":"MO Baerlocher","year":"2007","unstructured":"Baerlocher MO. Does sex affect residency application to surgery? Can J Surg. 2007;50(6):434\u20136.","journal-title":"Can J Surg"},{"key":"5071_CR9","doi-asserted-by":"crossref","first-page":"178","DOI":"10.5116\/ijme.5403.2b71","volume":"5","author":"M Alers","year":"2014","unstructured":"Alers M, Verdonk P, Bor H, Hamberg K, Lagro-Janssen A. Gendered career considerations consolidate from the start of medical education. Int J Med Educ. 2014;5:178\u201384.","journal-title":"Int J Med Educ"},{"key":"5071_CR10","first-page":"18","volume":"5","author":"P Maseghe Mwachaka","year":"2010","unstructured":"Maseghe Mwachaka P, Thuo Mbugua E. Specialty preferences among medical students in a Kenyan university. Pan Afr Med J. 2010;5:18.","journal-title":"Pan Afr Med J"},{"issue":"6","key":"5071_CR11","first-page":"509","volume":"13","author":"S Parsa","year":"2010","unstructured":"Parsa S, Aghazadeh A, Nejatisafa AA, Amini H, Mohammadi MR, Mostafazadeh B, et al. Freshmen versus interns\u2019 specialty interests. Arch Iran Med. 2010;13(6):509\u201315.","journal-title":"Arch Iran Med"},{"key":"5071_CR12","doi-asserted-by":"crossref","first-page":"15","DOI":"10.1186\/1472-6920-10-15","volume":"10","author":"Y Fukuda","year":"2010","unstructured":"Fukuda Y, Harada T. Gender differences in specialty preference and mismatch with real needs in Japanese medical students. BMC Med Educ. 2010;10:15.","journal-title":"BMC Med Educ"},{"issue":"6","key":"5071_CR13","doi-asserted-by":"crossref","first-page":"443","DOI":"10.1007\/S40037-014-0149-5","volume":"3","author":"M Alers","year":"2014","unstructured":"Alers M, Pepping T, Bor H, Verdonk P, Hamberg K, Lagro-Janssen A. Speciality preferences in Dutch medical students influenced by their anticipation on family responsibilities. Perspect Med Educ. 2014;3(6):443\u201354.","journal-title":"Perspect Med Educ"},{"issue":"7","key":"5071_CR14","doi-asserted-by":"crossref","first-page":"1095","DOI":"10.1007\/s11606-008-0579-z","volume":"23","author":"MT Compton","year":"2008","unstructured":"Compton MT, Frank E, Elon L, Carrera J. Changes in U.S. medical students\u2019 specialty interests over the course of medical school. J Gen Intern Med. 2008;23(7):1095\u2013100.","journal-title":"J Gen Intern Med"},{"key":"5071_CR15","doi-asserted-by":"crossref","unstructured":"Lagro-Janssen A. Gendered specialities during medical education: a literature review. 2014;3(3):163.","DOI":"10.1007\/S40037-014-0132-1"},{"key":"5071_CR16","unstructured":"Wenger E. Communities of Practice: Learning as a Social System. 2008."},{"issue":"2","key":"5071_CR17","doi-asserted-by":"crossref","first-page":"185","DOI":"10.1097\/ACM.0000000000001826","volume":"93","author":"RL Cruess","year":"2018","unstructured":"Cruess RL, Cruess SR, Steinert Y. Medicine as a community of practice: implications for Medical Education. Acad Med. 2018;93(2):185.","journal-title":"Acad Med"},{"issue":"6","key":"5071_CR18","doi-asserted-by":"crossref","first-page":"547","DOI":"10.1111\/medu.12134","volume":"47","author":"E Hill","year":"2013","unstructured":"Hill E, Vaughan S. The only girl in the room: how paradigmatic trajectories deter female students from surgical careers. Med Educ. 2013;47(6):547\u201356.","journal-title":"Med Educ"},{"issue":"4","key":"5071_CR19","doi-asserted-by":"crossref","first-page":"527","DOI":"10.1097\/ACM.0b013e31828578bb","volume":"88","author":"RB Levine","year":"2013","unstructured":"Levine RB, Mechaber HF, Reddy ST, Cayea D, Harrison RA. A good Career choice for women: Female Medical Students\u2019 mentoring experiences: a multi-institutional qualitative study. Acad Med. 2013;88(4):527.","journal-title":"Acad Med"},{"issue":"6","key":"5071_CR20","doi-asserted-by":"crossref","first-page":"742","DOI":"10.1016\/j.amjsurg.2005.03.019","volume":"189","author":"A Cochran","year":"2005","unstructured":"Cochran A, Melby S, Neumayer LA. An internet-based survey of factors influencing medical student selection of a general surgery career. Am J Surg. 2005;189(6):742\u20136.","journal-title":"Am J Surg"},{"issue":"4","key":"5071_CR21","doi-asserted-by":"crossref","first-page":"405","DOI":"10.1001\/archsurg.141.4.405","volume":"141","author":"DA Gargiulo","year":"2006","unstructured":"Gargiulo DA, Hyman NH, Hebert JC. Women in surgery: do we really understand the deterrents? Arch Surg. 2006;141(4):405\u20137. discussion 407\u2013408.","journal-title":"Arch Surg"},{"issue":"4","key":"5071_CR22","doi-asserted-by":"crossref","first-page":"225","DOI":"10.1177\/229255031502300410","volume":"23","author":"E Krauss","year":"2015","unstructured":"Krauss E, Bezuhly M, Williams J. Selecting the best and brightest: a comparison of residency match processes in the United States and Canada. Plast Surg (Oakv). 2015;23(4):225\u201330.","journal-title":"Plast Surg (Oakv)"},{"issue":"2","key":"5071_CR23","doi-asserted-by":"crossref","first-page":"263","DOI":"10.1016\/j.amjsurg.2012.07.044","volume":"206","author":"A Cochran","year":"2013","unstructured":"Cochran A, Hauschild T, Elder WB, Neumayer LA, Brasel KJ, Crandall ML. Perceived gender-based barriers to careers in academic surgery. Am J Surg. 2013;206(2):263\u20138.","journal-title":"Am J Surg"},{"issue":"4","key":"5071_CR24","doi-asserted-by":"crossref","first-page":"506","DOI":"10.1097\/ACM.0b013e318248f718","volume":"87","author":"DJ Burgess","year":"2012","unstructured":"Burgess DJ, Joseph A, van Ryn M, Carnes M. Does stereotype threat affect women in Academic Medicine? Acad Med. 2012;87(4):506\u201312.","journal-title":"Acad Med"},{"issue":"5","key":"5071_CR25","doi-asserted-by":"crossref","first-page":"453","DOI":"10.1097\/00001888-200105000-00017","volume":"76","author":"MJ Yedidia","year":"2001","unstructured":"Yedidia MJ, Bickel J. Why aren\u2019t there more women leaders in Academic Medicine? The views of Clinical Department Chairs. Acad Med. 2001;76(5):453.","journal-title":"Acad Med"},{"issue":"4","key":"5071_CR26","doi-asserted-by":"crossref","first-page":"559","DOI":"10.1016\/j.amjsurg.2016.06.006","volume":"212","author":"F Webster","year":"2016","unstructured":"Webster F, Rice K, Christian J, Seemann N, Baxter N, Moulton CA, et al. The erasure of gender in academic surgery: a qualitative study. Am J Surg. 2016;212(4):559\u201365.","journal-title":"Am J Surg"},{"issue":"6","key":"5071_CR27","doi-asserted-by":"crossref","first-page":"718","DOI":"10.1097\/ACM.0000000000000700","volume":"90","author":"RL Cruess","year":"2015","unstructured":"Cruess RL, Cruess SR, Boudreau JD, Snell L, Steinert Y. A schematic representation of the Professional identity formation and socialization of medical students and residents: a guide for medical educators. Acad Med. 2015;90(6):718.","journal-title":"Acad Med"},{"key":"5071_CR28","doi-asserted-by":"publisher","unstructured":"Riska E. Women in the Medical Profession: International Trends. In: Kuhlmann E, Annandale E, editors. The Palgrave Handbook of Gender and Healthcare [Internet]. London: Palgrave Macmillan UK; 2010 [cited 2023 Mar 10]. p. 389\u2013404. https:\/\/doi.org\/10.1057\/9780230290334_24.","DOI":"10.1057\/9780230290334_24"},{"issue":"8","key":"5071_CR29","doi-asserted-by":"crossref","first-page":"1253","DOI":"10.1016\/S0277-9536(00)00043-5","volume":"51","author":"BL Beagan","year":"2000","unstructured":"Beagan BL. Neutralizing differences: producing neutral doctors for (almost) neutral patients. Soc Sci Med. 2000;51(8):1253\u201365.","journal-title":"Soc Sci Med"},{"issue":"9","key":"5071_CR30","doi-asserted-by":"crossref","first-page":"1103","DOI":"10.1001\/jama.296.9.1103","volume":"296","author":"D Sambunjak","year":"2006","unstructured":"Sambunjak D, Straus SE, Maru\u0161i\u0107 A. Mentoring in academic MedicineA systematic review. JAMA. 2006;296(9):1103\u201315.","journal-title":"JAMA"},{"issue":"4","key":"5071_CR31","doi-asserted-by":"crossref","first-page":"236","DOI":"10.1207\/S15328015TLM1404_6","volume":"14","author":"AB Reisman","year":"2002","unstructured":"Reisman AB, Gross CP. Gender differences in the ability to identify a mentor at morning report: a multi-institutional survey. Teach Learn Med. 2002;14(4):236\u20139.","journal-title":"Teach Learn Med"},{"key":"5071_CR32","doi-asserted-by":"crossref","unstructured":"Waugh E, Schipper S, Ross S. Female doctors in Canada: experience and culture. University of Toronto Press; 2019. p. 303.","DOI":"10.3138\/9781487519766"},{"issue":"3","key":"5071_CR33","doi-asserted-by":"crossref","first-page":"266","DOI":"10.1177\/000313482008600339","volume":"86","author":"MS Altieri","year":"2020","unstructured":"Altieri MS, Price KL, Yang J, Jones DB, Pryor AD. What are women being advised by mentors when applying to surgery? Am Surg. 2020;86(3):266\u201372.","journal-title":"Am Surg"},{"issue":"5","key":"5071_CR34","doi-asserted-by":"crossref","first-page":"344","DOI":"10.7326\/M13-0974","volume":"160","author":"S Jolly","year":"2014","unstructured":"Jolly S, Griffith KA, DeCastro R, Stewart A, Ubel P, Jagsi R. Gender differences in Time Spent on parenting and domestic responsibilities by high-achieving Young Physician-Researchers. Ann Intern Med. 2014;160(5):344\u201353.","journal-title":"Ann Intern Med"},{"issue":"1","key":"5071_CR35","doi-asserted-by":"crossref","first-page":"137","DOI":"10.1213\/ANE.0000000000003691","volume":"128","author":"MA Bissing","year":"2019","unstructured":"Bissing MA, Lange EMS, Davila WF, Wong CA, McCarthy RJ, Stock MC, et al. Status of women in academic anesthesiology: a 10-Year update. Anesth Analg. 2019;128(1):137\u201343.","journal-title":"Anesth Analg"},{"issue":"12","key":"5071_CR36","doi-asserted-by":"crossref","first-page":"1867","DOI":"10.1089\/jwh.2011.2906","volume":"20","author":"TR Long","year":"2011","unstructured":"Long TR, Elliott BA, Warner ME, Brown MJ, Rose SH. Resident and program director gender distribution by Specialty. J Women\u2019s Health. 2011;20(12):1867\u201370.","journal-title":"J Women\u2019s Health"},{"issue":"12","key":"5071_CR37","doi-asserted-by":"crossref","first-page":"e56","DOI":"10.2106\/JBJS.18.00320","volume":"101","author":"K Okike","year":"2019","unstructured":"Okike K, Phillips DP, Swart E, O\u2019Connor MI. Orthopaedic Faculty and Resident Sex Diversity are Associated with the Orthopaedic Residency Application Rate of Female Medical Students. JBJS. 2019;101(12):e56.","journal-title":"JBJS"},{"issue":"1","key":"5071_CR38","doi-asserted-by":"crossref","first-page":"141","DOI":"10.1016\/j.amjsurg.2005.04.008","volume":"190","author":"J Park","year":"2005","unstructured":"Park J, Minor S, Taylor RA, Vikis E, Poenaru D. Why are women deterred from general surgery training? Am J Surg. 2005;190(1):141\u20136.","journal-title":"Am J Surg"},{"issue":"1","key":"5071_CR39","doi-asserted-by":"crossref","first-page":"23","DOI":"10.1016\/j.jamcollsurg.2009.08.011","volume":"210","author":"N Ahmadiyeh","year":"2010","unstructured":"Ahmadiyeh N, Cho NL, Kellogg KC, Lipsitz SR, Moore FDJ, Ashley SW, et al. Career satisfaction of women in surgery: perceptions, factors, and strategies. J Am Coll Surg. 2010;210(1):23.","journal-title":"J Am Coll Surg"},{"issue":"1","key":"5071_CR40","doi-asserted-by":"crossref","first-page":"37","DOI":"10.1097\/00000658-199307000-00007","volume":"218","author":"CL Mizgala","year":"1993","unstructured":"Mizgala CL, Mackinnon SE, Walters BC, Ferris LE, McNeill IY, Knighton T. Women surgeons. Results of the Canadian Population Study. Ann Surg. 1993;218(1):37\u201346.","journal-title":"Ann Surg"},{"issue":"7","key":"5071_CR41","doi-asserted-by":"crossref","first-page":"635","DOI":"10.1001\/archsurg.2009.120","volume":"144","author":"KM Troppmann","year":"2009","unstructured":"Troppmann KM, Palis BE, Goodnight JE, Ho HS, Troppmann C. Women surgeons in the new millennium. Arch Surg. 2009;144(7):635\u201342.","journal-title":"Arch Surg"},{"issue":"2","key":"5071_CR42","doi-asserted-by":"crossref","first-page":"211","DOI":"10.1001\/archsurg.2010.310","volume":"146","author":"LN Dyrbye","year":"2011","unstructured":"Dyrbye LN, Shanafelt TD, Balch CM, Satele D, Sloan J, Freischlag J. Relationship between work-home conflicts and Burnout among American surgeons: a comparison by sex. Arch Surg. 2011;146(2):211\u20137.","journal-title":"Arch Surg"},{"issue":"11","key":"5071_CR43","doi-asserted-by":"crossref","first-page":"1004","DOI":"10.1001\/jamasurg.2018.2571","volume":"153","author":"EL Rangel","year":"2018","unstructured":"Rangel EL, Lyu H, Haider AH, Castillo-Angeles M, Doherty GM, Smink DS. Factors Associated with Residency and Career Dissatisfaction in Childbearing Surgical residents. JAMA Surg. 2018;153(11):1004\u201311.","journal-title":"JAMA Surg"},{"issue":"10","key":"5071_CR44","doi-asserted-by":"crossref","first-page":"952","DOI":"10.1001\/jamasurg.2019.2985","volume":"154","author":"MS Altieri","year":"2019","unstructured":"Altieri MS, Salles A, Bevilacqua LA, Brunt LM, Mellinger JD, Gooch JC, et al. Perceptions of surgery residents about parental leave during training. JAMA Surg. 2019;154(10):952\u20138.","journal-title":"JAMA Surg"},{"issue":"7","key":"5071_CR45","doi-asserted-by":"crossref","first-page":"E244","DOI":"10.1503\/cmaj.200951","volume":"193","author":"AC Tricco","year":"2021","unstructured":"Tricco AC, Bourgeault I, Moore A, Grunfeld E, Peer N, Straus SE. Advancing gender equity in medicine. CMAJ. 2021;193(7):E244\u201350.","journal-title":"CMAJ"},{"issue":"6","key":"5071_CR46","doi-asserted-by":"crossref","first-page":"e1","DOI":"10.1016\/j.jsurg.2019.07.024","volume":"76","author":"KL Barnes","year":"2019","unstructured":"Barnes KL, McGuire L, Dunivan G, Sussman AL, McKee R. Gender Bias experiences of Female Surgical trainees. J Surg Educ. 2019;76(6):e1\u201314.","journal-title":"J Surg Educ"},{"issue":"10","key":"5071_CR47","doi-asserted-by":"crossref","first-page":"721","DOI":"10.7326\/M17-3438","volume":"168","author":"R Butkus","year":"2018","unstructured":"Butkus R, Serchen J, Moyer DV, Bornstein SS, Hingle ST. Achieving gender equity in Physician Compensation and Career Advancement: A position paper of the American College of Physicians. Ann Intern Med. 2018;168(10):721\u20133.","journal-title":"Ann Intern Med"}],"container-title":["BMC Medical Education"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12909-024-05071-4.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12909-024-05071-4\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12909-024-05071-4.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,1,31]],"date-time":"2024-01-31T09:03:03Z","timestamp":1706691783000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmcmededuc.biomedcentral.com\/articles\/10.1186\/s12909-024-05071-4"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,1,30]]},"references-count":47,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2024,12]]}},"alternative-id":["5071"],"URL":"https:\/\/doi.org\/10.1186\/s12909-024-05071-4","relation":{},"ISSN":["1472-6920"],"issn-type":[{"value":"1472-6920","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,1,30]]},"assertion":[{"value":"23 May 2023","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"18 January 2024","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"30 January 2024","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors declare no competing interests.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}}],"article-number":"100"}}