L. Gade1,2, A. Watkins1, H. Yeo1 1Weill Cornell Medical College,Surgery,New York, NY, USA 2New York Hospital Queens,Surgery,Flushing, NY, USA
Introduction: Studies assessing the practice patterns of attending surgeons have demonstrated gender based differences in subspecialty choice for surgeons who pursued fellowship and gender differences in the types of cases performed by general surgeons who did not pursue fellowship. It is possible that gender disparities in practice patterns at the attending level may be driven by exposure and experience at the resident level. However, gender differences in resident operative exposure have not been studied. In this study, we compare differences in case volume and case type based on resident gender.
Methods: The cumulative 5 year ACGME resident case logs for all general surgery residents who completed training between 2015-2016 at two different surgery programs were obtained. 13 residents, 2 women and 11 men, were included. Cases were subdivided into 17 categories including 16 ACGME categories plus all cases labeled “Not for major credit” by assigning each current procedural terminology (CPT) code to one ACGME category using the ACGME’s “Tracked Codes Report”. CPT codes that fell under more than one category were assigned to one category. CPT codes from “Nonoperative Trauma” and “Critical Care” categories were removed. Total number of cases and cases performed in individual categories were stratified by gender. T-test and chi square were used where appropriate.
Results: Among the 13 residents, 16,414 cases were performed. There was no significant difference in the number of cases performed by men and women (1,285 +/- 188 vs 1,137 +/- 119, p=.156). Women performed significantly more breast (11.13% vs 7.31%, p<0.05) and endocrine (6.16% vs 2.70%, p<0.05) cases while men performed significantly more alimentary tract (10.32% vs 8.53%, p<.05), abdomen (14.9% vs 12.5%, p<.05), and vascular (8.39% vs 6.11%, p<.05) cases.
Conclusion:This pilot study demonstrates that while the volume of cases that male and female residents perform is similar, breast and endocrine cases comprise a significantly higher percent of female residents’ case volume while alimentary tract, abdomen, and vascular cases comprise a significantly higher percent of male residents’ case volume. Because their exposure is different than that of their male colleagues, this may affect female fellowship choice, confidence in underexposed subspecialties, and ultimately, career trajectory. Poor representation of women attendings in multiple general surgery subspecialties may deferentially impact trainees’ access to role models and may perpetuate stereotypes and bias in general surgery. The gender difference in case distribution seen in this study may also be related to the underrepresentation of women attendings in multiple subspecialties. We are working to expand this pilot study on a larger scale to be more representative. Further research must be done on a national level to assess gender equity in surgical training.