Assessment of Autonomy in Operative Procedures Among Female and Male New Zealand General Surgery Trainees

Joh, Daniel; Werf, Bert van der; Watson, B; French, R A; Bann, Simon; Dennet, Elizabeth; Loveday, Benjamin

doi:10.1001/jamasurg.2020.3021

Cited by 26 publications

(37 citation statements)

References 27 publications

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“…Within surgery, a 2020 study found that trainee gender did not impact evaluations of meaningful autonomy in the operating room ( 14 ). In contrast, other studies have reported lower autonomy among women surgical trainees ( 15 , 16 ). Whether gender differences are detected may also depend on the type of competencies being assessed as well as the timing of these evaluations.…”

Section: Discussioncontrasting

confidence: 60%

Impact of Gender on Clinical Evaluation of Trainees in the Intensive Care Unit

Spring

Abrahams²,

Ginsburg

et al. 2021

ATS Scholar

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Background: Gender disparities in medical education are increasingly demonstrated, including in trainee assessment. Objective: This study aimed to evaluate whether gender differences exist in trainees’ evaluation during intensive care unit (ICU) rotations, which has not been previously studied. Methods: We reviewed the in-training evaluation reports (ITERs) for trainees rotating through five academic ICUs at the University of Toronto over a 10-year period (2007–2017). We compared the mean global score for the rotation and the mean score for seven training subdomains between men and women trainees. All scores were reported on a scale of 1 (unsatisfactory) to 5 (outstanding). Results: Over the 10-year period, there were 3,203 ITERS overall, representing 1,207 women and 1,996 men trainees. The mean overall score was lower for women than for men trainees: 4.26 (standard deviation [SD], 0.58) for women and 4.30 (SD, 0.60) for men ( P = 0.04). This difference was driven by anesthesia trainees, in whom the mean overall score was 4.21 for women and 4.37 for men ( P < 0.001), with men trainees scoring consistently higher across all seven training subdomains. Within surgical, internal medicine, and critical care residents, there were no differences between men and women in the overall score or the scores across any of the seven subdomains. Across all ITERS, women were less likely than men to receive an overall rating of 5 (outstanding) for the ICU rotation (33% women vs. 37% men; odds ratio, 0.83; 95% confidence interval, 0.71–0.96). Conclusion: Overall, quantitative evaluation scores between women and men trainees in the ICU are relatively similar. Within anesthesia trainees, scores for men were consistently higher across all domains of evaluation, a finding that requires further investigation.

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Section: Discussioncontrasting

confidence: 60%

Impact of Gender on Clinical Evaluation of Trainees in the Intensive Care Unit

Spring

Abrahams²,

Ginsburg

et al. 2021

ATS Scholar

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“… 21 A 2019 study found that female general surgery residents in the USA were significantly less likely to be granted operative autonomy by faculty than men, 7 similar findings were seen among New Zealand general surgery trainees. 22 The finding that women across all specialties have adverse outcomes requires investigation at the specialty level.…”

Section: Discussionmentioning

confidence: 99%

Differences in progression by surgical specialty: a national cohort study

et al. 2022

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The aim of surgical training across the 10 surgical specialties is to produce competent day 1 consultants. Progression through training in the UK is assessed by the Annual Review of Competency Progression (ARCP).ObjectiveThis study aimed to examine variation in ARCP outcomes within surgical training and identify differences in outcomes between specialties.DesignA national cohort study using data from the UK Medical Education Database was performed. ARCP outcome was the primary outcome measure. Multilevel ordinal regression analyses were performed, with ARCP outcomes nested within trainees.ParticipantsHigher surgical trainees (ST3–ST8) from nine UK surgical specialties were included (vascular surgery was excluded due to insufficient data). All surgical trainees across the UK with an ARCP outcome between 2010 and 2017 were included.ResultsEight thousand two hundred and twenty trainees with an ARCP outcome awarded between 2010 and 2017 were included, comprising 31 788 ARCP outcomes. There was substantial variation in the proportion of non-standard outcomes recorded across specialties with general surgery trainees having the highest proportion of non-standard outcomes (22.5%) and urology trainees the fewest (12.4%). After adjustment, general surgery trainees were 1.3 times more likely to receive a non-standard ARCP outcome compared with trainees in trauma and orthopaedics (T&O) (OR 1.33, 95% CI 1.21 to 1.45, p=0.001). Urology trainees were 36% less likely to receive a non-standard outcome compared with T&O trainees (OR 0.64, 95% CI 0.54 to 0.75, p<0.001). Female trainees and older age were associated with non-standard outcomes (OR 1.11, 95% CI 1.02 to 1.22, p=0.020; OR 1.04, 95% CI 1.03 to 1.05, p<0.001).ConclusionThere is wide variation in the training outcome assessments across surgical specialties. General surgery has higher rates of non-standard outcomes compared with other surgical specialties. Across all specialties, female sex and older age were associated with non-standard outcomes.

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“…In a meta-analysis comprising 17,407 surgical trainees across the world, women were found to have a higher pooled attrition than men[20]. A 2019 study found that female general surgery residents in the US were significantly less likely to be granted operative autonomy by faculty than men[6], similar findings were seen amongst New Zealand general surgery trainees[21]. The finding that women across all specialities have adverse outcomes requires investigation at the specialty level.…”

Section: Discussionmentioning

confidence: 99%

Differences in progression by surgical specialty: a national cohort study

Hope

Lund

Griffiths

et al. 2021

Preprint

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The aim of surgical training across the ten surgical specialties is to produce competent day one consultants. Progression through training is assessed by the Annual Review of Competency Progression (ARCP). Objective This study aimed to examine variation in ARCP outcomes within surgical training and identify differences between specialties. Design A national cohort study using data from United Kingdom Medical Education Database (UKMED) was performed. ARCP outcome was the primary outcome measure. Multi-level ordinal regression analyses were performed, with ARCP outcomes nested within trainees. Participants Higher surgical trainees (ST3-ST8) from 9 UK surgical specialties were included (vascular surgery was excluded due to insufficient data). All surgical trainees across the UK with an ARCP outcome between 2010 to 2017 were included. Results Eight thousand two hundred and twenty trainees with an ARCP outcome awarded between 2010 and 2017 were included, comprising 31,788 ARCP outcomes. There was substantial variation in the proportion of non-standard outcomes recorded across specialties with general surgery trainees having the highest proportion of non-standard outcomes (22.5%) and urology trainees the fewest 12.4%. After adjustment, general surgery trainees were 1.3 times more likely to receive a non-standard ARCP outcome compared to trainees in T&O (OR 1.33 95%CI 1.21-1.45). Urology trainees were 36% less likely to receive a non-standard outcome compared to T&O trainees (OR 0.64 95%CI 0.54-0.75). Female trainees and older age were associated with non-standard outcomes (OR 1.11 95%CI 1.02-1.22; OR 1.04 95%CI 1.03-1.05). Conclusion There is wide variation in the training outcome assessments across surgical specialties. General surgery has higher rates of non-standard outcomes compared to other surgical specialities. Across all specialities, female sex and older age were associated with non-standard outcomes.

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Assessment of Autonomy in Operative Procedures Among Female and Male New Zealand General Surgery Trainees

Cited by 26 publications

References 27 publications

Impact of Gender on Clinical Evaluation of Trainees in the Intensive Care Unit

Impact of Gender on Clinical Evaluation of Trainees in the Intensive Care Unit

Differences in progression by surgical specialty: a national cohort study

Differences in progression by surgical specialty: a national cohort study

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