{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,4]],"date-time":"2026-02-04T00:31:10Z","timestamp":1770165070043,"version":"3.49.0"},"reference-count":36,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2026,1,3]],"date-time":"2026-01-03T00:00:00Z","timestamp":1767398400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,2,3]],"date-time":"2026-02-03T00:00:00Z","timestamp":1770076800000},"content-version":"vor","delay-in-days":31,"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>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Female medical students and doctors (women in medicine) face systemic gender biases, cultural expectations, and marital pressures that are linked to their career trajectories, leadership opportunities, and well-being. This study explores these barriers globally, assessing their connection to gender equity, career advancement, and retention in medicine.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To evaluate how marital and cultural pressures relate to the career progression and emotional well-being of women in medicine.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      A cross-sectional online survey using convenience and snowball sampling was disseminated globally through the Hub-and-Spokes model between November 2023 and December 2023. Responses (\n                      <jats:italic>N<\/jats:italic>\n                      \u2009=\u20093,031) from 53 countries were analysed in SPSS after consolidating Likert scales into three categories.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Most respondents (78.7%,\n                      <jats:italic>N<\/jats:italic>\n                      \u2009=\u20092386) reported that female doctors face greater societal expectations to marry, and 72.4% (\n                      <jats:italic>N<\/jats:italic>\n                      \u2009=\u20092195) noted that these expectations correspond with career choices. Marriage-related pressure from family or friends was reported by 61.5% (\n                      <jats:italic>N<\/jats:italic>\n                      \u2009=\u20091865). Over half agreed that women are expected to prioritise child-rearing (51.2%,\n                      <jats:italic>N<\/jats:italic>\n                      \u2009=\u20091552) or work part-time (52.7%,\n                      <jats:italic>N<\/jats:italic>\n                      \u2009=\u20091597). These pressures correlated with high stress (72.9%), guilt or self-blame (68.6%), and burnout (70.3%). Reported coping strategies included open communication with partners (84.6%), boundary setting (76.7%), and family or mentor support systems (72%).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Societal and cultural pressures remain closely linked to the professional and personal challenges of women in medicine. Targeted policy reforms and supportive workplace structures are needed to promote gender equity and well-being in medicine.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s12909-025-08519-3","type":"journal-article","created":{"date-parts":[[2026,1,4]],"date-time":"2026-01-04T02:17:18Z","timestamp":1767493038000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Influence of marital pressures and cultural constructs on females (IMPACT-F): a global study of female medical students and doctors"],"prefix":"10.1186","volume":"26","author":[{"ORCID":"https:\/\/orcid.org\/0009-0002-1230-9163","authenticated-orcid":false,"given":"Umme Summaiya","family":"Faisal","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ahmedyar","family":"Hasan","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sally","family":"Shayeb","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8790-523X","authenticated-orcid":false,"given":"Azeezat","family":"Oyewande","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7920-430X","authenticated-orcid":false,"given":"Majid","family":"Omari","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nino","family":"Dekanoidze","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Awranoos","family":"Ahadi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maryam","family":"Asif","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Aron","family":"Shrestha","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sharanya Ezhilarasan","family":"Santhi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Umme Habiba","family":"Faisal","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kamal Kishan","family":"Akash","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Norma Nicole Gamarra","family":"Valverde","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Israa Ahmed","family":"Qutob","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Naiela Ennaji","family":"Almansouri","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Darja","family":"Golubeva","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ashmita","family":"Yadav","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mikias Lewoyehu","family":"Wondie","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zabi","family":"Fatima","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jaiprakash Suresh","family":"Gurav","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Reshon","family":"Hadmon","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Romana","family":"Riyaz","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sameer Asim","family":"Khan","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Roopali","family":"Dahiya","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alen Sam","family":"Saji","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christos","family":"Tsagkaris","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ahmed","family":"Ramzi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rawan Tarek","family":"Fathi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alaa","family":"Khogali","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Faisal A.","family":"Nawaz","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4383-3411","authenticated-orcid":false,"given":"Rahul","family":"Kashyap","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5888-6663","authenticated-orcid":false,"given":"Zara","family":"Arshad","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2026,1,3]]},"reference":[{"key":"8519_CR1","unstructured":"Association of American Medical Colleges. The majority of U.S. medical students are women: new data show. Washington (DC): AAMC. 2019. Available from: https:\/\/www.aamc.org\/news\/press-releases\/majority-us-medical-students-are-women-new-data-show . [cited 2025 Sep 7]."},{"key":"8519_CR2","doi-asserted-by":"publisher","first-page":"353","DOI":"10.1136\/sbmj.020353","volume":"324","author":"S Chaudhry","year":"2002","unstructured":"Chaudhry S. Women medical students exceed quota in Singapore. BMJ. 2002;324:353.","journal-title":"BMJ"},{"key":"8519_CR3","doi-asserted-by":"publisher","first-page":"748","DOI":"10.1136\/bmj.39505.491065.94","volume":"336","author":"B McKinstry","year":"2008","unstructured":"McKinstry B. Are there too many female medical graduates? Yes. BMJ. 2008;336:748.","journal-title":"BMJ"},{"issue":"10","key":"8519_CR4","first-page":"411","volume":"9","author":"Y Senoo","year":"2020","unstructured":"Senoo Y, Takita M, Ozaki A, Kami M. The proportion of female physicians links with advanced educational opportunity for female and by female. Int J Health Policy Manag. 2020;9(10):411\u20132.","journal-title":"Int J Health Policy Manag"},{"key":"8519_CR5","unstructured":"World Health Organization. Delivered by women, led by men: a gender and equity analysis of the global health and social workforce. Geneva: WHO; 2019. Available from: https:\/\/iris.who.int\/handle\/10665\/311322 . [cited 2025 Sep 7]."},{"key":"8519_CR6","unstructured":"World Health Organization. Value gender and equity in the global health workforce. Geneva: WHO; 2024. Available from: https:\/\/www.who.int\/activities\/value-gender-and-equity-in-the-global-health-workforce . [cited 2025 Sep 7]."},{"issue":"3","key":"8519_CR7","first-page":"185","volume":"120","author":"MA Jackson","year":"2023","unstructured":"Jackson MA. The leaky pipeline in academia. Mo Med. 2023;120(3):185\u20137.","journal-title":"Mo Med"},{"key":"8519_CR8","unstructured":"Harris B. Women in leadership: a qualitative review of challenges, experiences, and strategies in addressing gender bias [dissertation]. Worcester (MA): Clark University; 2019."},{"key":"8519_CR9","unstructured":"Statista. Infographic: when people get married around the world. Hamburg: Statista; 2021. Available from: https:\/\/www.statista.com\/chart\/19119\/global-marriage-ages . [cited 2025 Sep 7]."},{"key":"8519_CR10","unstructured":"Johns Hopkins University. After graduation. Baltimore (MD): JHU Pre-Professional Advising; 2024. Available from: https:\/\/studentaffairs.jhu.edu\/preprofadvising\/pre-medhealth\/after-graduation . [cited 2025 Sep 7]"},{"issue":"1","key":"8519_CR11","doi-asserted-by":"publisher","first-page":"105","DOI":"10.1177\/09722629211024887","volume":"26","author":"J Chauhan","year":"2022","unstructured":"Chauhan J, Mishra G, Bhakri S. Career success of women: role of family responsibilities, mentoring, and perceived organizational support. Vision. 2022;26(1):105\u201317.","journal-title":"Vision"},{"issue":"11","key":"8519_CR12","first-page":"16","volume":"9","author":"W Teshome","year":"2019","unstructured":"Teshome W, Baharu F, Sisay S, Fura ML. Challenges of work-life balance and coping strategies among married women Doctors with children in Yekatit-12 hospital. Res Humanit Soc Sci. 2019;9(11):16\u201322.","journal-title":"Res Humanit Soc Sci"},{"key":"8519_CR13","unstructured":"International Labour Organization. International day of families: how marital status shapes labour market outcomes. Geneva: ILO; 2020. Available from: https:\/\/ilostat.ilo.org\/blog\/international-day-of-families-how-marital-status-shapes-labour-market-outcomes . [cited 2025 Sep 7]."},{"key":"8519_CR14","doi-asserted-by":"publisher","first-page":"681","DOI":"10.2147\/JMDH.S254922","volume":"13","author":"AM Alobaid","year":"2020","unstructured":"Alobaid AM, Gosling CM, Khasawneh E, et al. Challenges faced by female healthcare professionals in the workforce: a scoping review. J Multidiscip Healthc. 2020;13:681\u201391.","journal-title":"J Multidiscip Healthc"},{"key":"8519_CR15","doi-asserted-by":"publisher","first-page":"1330","DOI":"10.3389\/fpsyg.2018.01330","volume":"9","author":"J Cerrato","year":"2018","unstructured":"Cerrato J, Cifre E. Gender inequality in household chores and work-family conflict. Front Psychol. 2018;9:1330. https:\/\/doi.org\/10.3389\/fpsyg.2018.01330.","journal-title":"Front Psychol"},{"key":"8519_CR16","doi-asserted-by":"publisher","first-page":"04008","DOI":"10.7189\/jogh.14.04008","volume":"14","author":"T Amal","year":"2024","unstructured":"Amal T, Banga A, Bhatt G, et al. Guiding principles for the conduct of the violence study of healthcare workers and system (ViSHWaS): insights from a global survey. J Glob Health. 2024;14:04008. https:\/\/doi.org\/10.7189\/jogh.14.04008.","journal-title":"J Glob Health"},{"key":"8519_CR17","doi-asserted-by":"publisher","unstructured":"Banga A, Amal T, Bhatt G et al. Guiding principles for the conduct of the Violence Study of Healthcare Workers and System (ViSHWaS): insights from a global survey. ResearchGate; 2024. Available from: https:\/\/doi.org\/10.7189\/jogh.14.04008 . [cited 2025 Sep 7].","DOI":"10.7189\/jogh.14.04008"},{"issue":"11","key":"8519_CR18","doi-asserted-by":"publisher","first-page":"67670","DOI":"10.5812\/sdme.67670","volume":"6","author":"I Etikan","year":"2024","unstructured":"Etikan I, Alkassim R, Abubakar S. Snowball sampling: a purposeful method of sampling in qualitative research. SDME. 2024;6(11):67670. https:\/\/doi.org\/10.5812\/sdme.67670.","journal-title":"SDME"},{"key":"8519_CR19","unstructured":"World Bank. Country and lending groups. Washington (DC): World Bank; 2024. Available from: https:\/\/datahelpdesk.worldbank.org\/knowledgebase\/articles\/906519 . [cited 2025 Sep 7]"},{"key":"8519_CR20","doi-asserted-by":"publisher","first-page":"101626","DOI":"10.1016\/j.chieco.2021.101626","volume":"68","author":"J You","year":"2021","unstructured":"You J, Yi X, Chen M. Love, life, and leftover ladies in urban china: staying modernly single in patriarchal traditions. China Econ Rev. 2021;68:101626.","journal-title":"China Econ Rev"},{"key":"8519_CR21","doi-asserted-by":"publisher","unstructured":"Bhargava S. Working with young women facing pressure to marry. Int J Narrative Ther Community Work. 2022;2022:38\u201346. https:\/\/doi.org\/10.4320\/RLCG5609.","DOI":"10.4320\/RLCG5609"},{"issue":"12","key":"8519_CR22","doi-asserted-by":"publisher","first-page":"e0225763","DOI":"10.1371\/journal.pone.0225763","volume":"14","author":"J Garc\u00eda-Gonz\u00e1lez","year":"2019","unstructured":"Garc\u00eda-Gonz\u00e1lez J, Forc\u00e9n P, Jimenez-Sanchez M. Men and women differ in their perception of gender bias in research institutions. PLoS ONE. 2019;14(12):e0225763.","journal-title":"PLoS ONE"},{"issue":"5","key":"8519_CR23","doi-asserted-by":"publisher","first-page":"1478","DOI":"10.1111\/jomf.12426","volume":"79","author":"K Allendorf","year":"2017","unstructured":"Allendorf K, Thornton A, Mitchell C, et al. Early women, late men: timing attitudes and gender differences in marriage. J Marriage Fam. 2017;79(5):1478\u201396.","journal-title":"J Marriage Fam"},{"issue":"10","key":"8519_CR24","doi-asserted-by":"publisher","first-page":"e2326192","DOI":"10.1001\/jamanetworkopen.2023.26192","volume":"6","author":"JB Bakkensen","year":"2023","unstructured":"Bakkensen JB, Smith KS, Cheung EO, et al. Childbearing, infertility, and career trajectories among women in medicine. JAMA Netw Open. 2023;6(10):e2326192.","journal-title":"JAMA Netw Open"},{"key":"8519_CR25","doi-asserted-by":"publisher","first-page":"40","DOI":"10.1186\/1472-6963-10-40","volume":"10","author":"B Buddeberg-Fischer","year":"2010","unstructured":"Buddeberg-Fischer B, Stamm M, Buddeberg C, et al. The impact of gender and parenthood on physicians\u2019 careers: professional and personal situation seven years after graduation. BMC Health Serv Res. 2010;10:40. https:\/\/doi.org\/10.1186\/1472-6963-10-40.","journal-title":"BMC Health Serv Res"},{"key":"8519_CR26","unstructured":"McLeod S. Individualistic cultures. Simply Psychology; 2024. Available from: https:\/\/www.simplypsychology.org\/what-are-individualistic-cultures.html . [cited 2025 Oct 6]."},{"key":"8519_CR27","unstructured":"The Decision Lab. Collectivism. Montreal (CA): The Decision Lab; 2024.. Available from: https:\/\/thedecisionlab.com\/reference-guide\/psychology\/collectivism . [cited 2025 Oct 6]"},{"issue":"2","key":"8519_CR28","doi-asserted-by":"publisher","first-page":"118","DOI":"10.5958\/0976-0733.2020.00010.3","volume":"37","author":"NJ Nipu","year":"2020","unstructured":"Nipu NJ. Influence of collectivist societal culture on career choice: A study on the prospective job candidates of Bangladesh. Dyn Public Adm. 2020;37(2):118\u201332.","journal-title":"Dyn Public Adm"},{"key":"8519_CR29","doi-asserted-by":"publisher","first-page":"275361302412329","DOI":"10.1177\/27536130241232929","volume":"13","author":"V Karakcheyeva","year":"2024","unstructured":"Karakcheyeva V, Willis-Johnson H, Corr PG, et al. The well-being of women in healthcare professions: a comprehensive review. Glob Adv Integr Med Health. 2024;13:27536130241232929. https:\/\/doi.org\/10.1177\/27536130241232929.","journal-title":"Glob Adv Integr Med Health"},{"key":"8519_CR30","unstructured":"World Health Organization. Closing the leadership gap: gender equity and leadership in the global health and care workforce. Geneva: WHO; 2021. Available from: https:\/\/iris.who.int\/handle\/10665\/354443 . [cited 2025 Sep 7]."},{"key":"8519_CR31","unstructured":"McKinsey & Company. Meeting the challenge of moms\u2019. double double shift at home and work. New York: McKinsey & Company; 2025. Available from: https:\/\/www.mckinsey.com\/featured-insights\/sustainable-inclusive-growth\/future-of-america\/meeting-the-challenge-of-moms-double-double-shift-at-home-and-work . [cited 2025 Sep 7]."},{"key":"8519_CR32","first-page":"124","volume":"31","author":"O Ofiaeli","year":"2020","unstructured":"Ofiaeli O. Assessment of stress and its predictors among female medical Doctors. Niger J Med. 2020;31:124\u201330.","journal-title":"Niger J Med"},{"key":"8519_CR33","doi-asserted-by":"publisher","first-page":"92","DOI":"10.1186\/s12960-019-0427-2","volume":"17","author":"N El Arnaout","year":"2019","unstructured":"El Arnaout N, Chehab R, Rafii B, Alameddine M. Gender equity in planning, development and management of human resources for health: a scoping review. Hum Resour Health. 2019;17:92. https:\/\/doi.org\/10.1186\/s12960-019-0427-2.","journal-title":"Hum Resour Health"},{"issue":"6","key":"8519_CR34","doi-asserted-by":"publisher","first-page":"687","DOI":"10.1016\/j.oneear.2022.05.006","volume":"5","author":"RJ Shellock","year":"2022","unstructured":"Shellock RJ, Cvitanovic C, Mackay M, McKinnon MC, Blythe J, Kelly R, et al. Breaking down barriers: the identification of actions to promote gender equality in interdisciplinary marine research institutions. One Earth. 2022;5(6):687\u2013708. https:\/\/doi.org\/10.1016\/j.oneear.2022.05.006.","journal-title":"One Earth"},{"issue":"2","key":"8519_CR35","doi-asserted-by":"publisher","first-page":"130","DOI":"10.7812\/TPP\/23.023","volume":"27","author":"R Lyubarova","year":"2023","unstructured":"Lyubarova R, Salman L, Rittenberg E. Gender differences in physician burnout: driving factors and potential solutions. Perm J. 2023;27(2):130\u20136.","journal-title":"Perm J"},{"key":"8519_CR36","doi-asserted-by":"publisher","DOI":"10.31478\/201905a","author":"K Templeton","year":"2019","unstructured":"Templeton K, Bernstein C, Sukhera J, Nora LM, Newman C, Burstin H, et al. Gender-based differences in burnout: issues faced by women physicians. NAM Perspect. 2019. https:\/\/doi.org\/10.31478\/201905a.","journal-title":"NAM Perspect"}],"container-title":["BMC Medical Education"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12909-025-08519-3","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12909-025-08519-3.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12909-025-08519-3.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,2,3]],"date-time":"2026-02-03T11:38:50Z","timestamp":1770118730000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1186\/s12909-025-08519-3"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1,3]]},"references-count":36,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,12]]}},"alternative-id":["8519"],"URL":"https:\/\/doi.org\/10.1186\/s12909-025-08519-3","relation":{},"ISSN":["1472-6920"],"issn-type":[{"value":"1472-6920","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1,3]]},"assertion":[{"value":"11 May 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"23 December 2025","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"3 January 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Participation in the survey was entirely voluntary and optional. Informed consent was obtained through an online written form before survey completion. The study did not involve any patients, and no personally identifiable information was collected. It was therefore considered non-human subjects research.In accordance with 45 CFR 46.102 and based on the information submitted through the Mayo Clinic IRBe Human Subjects Research Wizard tool, the Mayo Clinic Institutional Review Board (IRB) determined that this activity does not require IRB review. The study was conducted in accordance with the ethical principles outlined in the Declaration of Helsinki.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"All survey participants were anonymised and gave consent for the publication of the study\u2019s results. Consent for the use of the data they provided was required to access and complete the survey, and it was obtained via the same online survey form.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"182"}}