The effect of gender on operative autonomy in general surgery residents

Abstract

Background: Despite an increasing number of women in the field of surgery, bias regarding cognitive or technical ability may continue to affect the experience of female trainees differently than their male counterparts. This study examines the differences in the degree of operative autonomy given to female compared with male general surgery trainees. Methods: A smartphone app was used to collect evaluations of operative autonomy measured using the 4-point Zwisch scale, which describes defined steps in the progression from novice ("show and tell") to autonomous surgeon ("supervision only"). Differences in autonomy between male and female residents were compared using hierarchical logistic regression analysis. Results: A total of 412 residents and 524 faculty from 14 general surgery training programs evaluated 8,900 cases over a 9-month period. Female residents received less autonomy from faculty than did male residents overall (P < .001). Resident level of training and case complexity were the strongest predictors of autonomy. Even after controlling for potential confounding factors, including level of training, intrinsic procedural difficulty, patient-related case complexity, faculty sex, and training program environment, female residents still received less operative autonomy than their male counterparts. The greatest discrepancy was in the fourth year of training.

Women in Leadership in Urology: The Case for Increasing Diversity and Equity

“…49 The explanation could stem from differences in societal upbringing or implicit gender bias, as we have previously discussed. Regardless of the reasons, the persistent gap in self-promotion has a definite impact on women in leadership and can translate into less autonomy in the operating room, 35,50,51 a decreased likelihood of applying for promotions, and less meaningful recommendations when they do apply for those opportunities. 44,52 Women must recognize that they can be their toughest critic and thus remind themselves to be confident and take full advantage of all opportunities.…”

Comparison of Performance Score for Female and Male Residents in General Surgery Doing Supervised Real‐Life Laparoscopic Appendectomy: Is There a Norse Shield‐Maiden Effect?

“…Previous studies have for the most part been conducted in a North American training system, in which most findings point to a systemic bias against female residents in training [ 7 , 19 – 21 ]. While a perceived bias of skills may be present in medical students, a systematic review found no difference in skills acquisition between gender in surgical residents [ 22 ].…”

“…However, being one of the largest units in general surgery in the country with a high volume of general surgery procedures and number of trainees, we believe the findings to be of wider interest and applicability. It also serves as a balanced report to the ongoing gender equity and disparity debates [ 3 , 7 , 11 , 33 – 35 ]. In the current study, we report how female residents in general surgery perceive their performance for an entry-level procedure such as laparoscopic appendectomy.…”

Functional linguistics: the lens and the looking glass

“…Meyerson et al. showed that even when controlling for level of training and procedural difficulty, female residents still receive less operative autonomy than their male counterparts . Social processes affect our written feedback to trainees and Isaac et al.…”

“…13 Meyerson et al showed that even when controlling for level of training and procedural difficulty, female residents still receive less operative autonomy than their male counterparts. 16 Social processes affect our written feedback to trainees and Isaac et al showed that evaluations of female medical students' performance were more likely to contain 'tentative' words. 17,18 How do these barriers affect learner confidence and opportunities for growth?…”