S. L. Meyerson1, D. D. Odell1, J. B. Zwischenberger2, M. Schuller1, J. D. Bohnen4, G. L. Dunnington3, L. Torbeck3, J. T. Mullen4, S. P. Mandell5, M. A. Choti6, E. Foley7, C. Are8, E. Auyang9, J. Chipman10, J. Choi3, A. Meier11, D. S. Smink12, K. P. Terhune13, P. E. Wise14, N. Soper1, K. Lillemoe4, J. P. Fryer1, B. C. George15 1Feinberg School Of Medicine – Northwestern University,Department Of Surgery,Chicago, IL, USA 2University Of Kentucky,Department Of Surgery,Lexington, KY, USA 3Indiana University School Of Medicine,Department Of Surgery,Indianapolis, IN, USA 4Massachusetts General Hospital,Department Of Surgery,Boston, MA, USA 5University Of Washington,Department Of Surgery,Seattle, WA, USA 6Banner MD Anderson Cancer Center,Department Of Surgery,Gilbert, AZ, USA 7University Of Wisconsin,Department Of Surgery,Madison, WI, USA 8University Of Nebraska College Of Medicine,Department Of Surgery,Omaha, NE, USA 9University Of New Mexico HSC,Department Of Surgery,Albuquerque, NM, USA 10University Of Minnesota,Department Of Surgery,Minneapolis, MN, USA 11State University Of New York Upstate Medical University,Department Of Surgery,Syracuse, NY, USA 12Brigham And Women’s Hospital,Department Of Surgery,Boston, MA, USA 13Vanderbilt University Medical Center,Department Of Surgery,Nashville, TN, USA 14Washington University,Department Of Surgery,St. Louis, MO, USA 15University Of Michigan,Department Of Surgery,Ann Arbor, MI, USA
Introduction: Despite an increasing number of women in surgery, bias regarding cognitive or technical ability may continue to impact the experience of female trainees differently than their male counterparts. The goal of this study is to examine differences between the degree of operative autonomy given to female and male surgical 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”) through increasing degrees of autonomy (“Active Help” to “Passive Help”) to competent to enter practice (“Supervision Only”). Autonomy was evaluated from both the faculty and resident perspectives. Differences in autonomy between male and female residents were compared using hierarchical logistic regression analysis.
Results: 412 residents and 524 faculty from 14 general surgery training programs evaluated 8900 cases over a 9 month period. Female residents received meaningful autonomy from faculty (“passive help” or “supervision only”) in 46.7% of cases (1053/2253) while male residents received meaningful autonomy in 52.7% of cases (1906/3614, p<0.001). 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 gender, and training program environment, female residents still received less operative autonomy than their male counterparts. The gap between autonomy granted to male and female residents was present from both the faculty and resident perspectives. The largest discrepancy was in the fourth year of training and both male and female faculty surgeons granted less autonomy to female residents.
Conclusion: There is a gender-based difference in the autonomy granted to general surgery trainees. This gender gap may affect female residents’ experience in training and possibly their preparation for practice. Strategies need to be developed to help faculty and residents work together to overcome this gender gap.
