The effect of gender on operative autonomy in general surgery residents.
Journal
Surgery
ISSN: 1532-7361
Titre abrégé: Surgery
Pays: United States
ID NLM: 0417347
Informations de publication
Date de publication:
11 2019
11 2019
Historique:
received:
18
01
2019
revised:
02
05
2019
accepted:
04
06
2019
pubmed:
22
7
2019
medline:
25
2
2020
entrez:
22
7
2019
Statut:
ppublish
Résumé
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. 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. 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. There is a sex-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.
Sections du résumé
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.
CONCLUSION
There is a sex-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.
Identifiants
pubmed: 31326184
pii: S0039-6060(19)30345-9
doi: 10.1016/j.surg.2019.06.006
pmc: PMC7382913
mid: NIHMS1607593
pii:
doi:
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
738-743Subventions
Organisme : NCI NIH HHS
ID : K07 CA216330
Pays : United States
Organisme : NCI NIH HHS
ID : L30 CA153420
Pays : United States
Informations de copyright
Copyright © 2019 Elsevier Inc. All rights reserved.
Références
J Surg Educ. 2014 Nov-Dec;71(6):e64-72
pubmed: 24924583
Trans Am Clin Climatol Assoc. 2015;126:197-214
pubmed: 26330674
Plast Reconstr Surg. 2016 Nov;138(5):1111-1116
pubmed: 27391836
J Surg Educ. 2014 Nov-Dec;71(6):e90-6
pubmed: 25192794
Acad Med. 2009 Oct;84(10):1440-6
pubmed: 19881440
Proc Natl Acad Sci U S A. 2012 Oct 9;109(41):16474-9
pubmed: 22988126
Acad Med. 1996 Jan;71(1 Suppl):S113-8
pubmed: 8546767
Acad Med. 2010 Apr;85(4):647-53
pubmed: 20354381
J Am Coll Surg. 2014 Oct;219(4):778-87
pubmed: 25158911
Patient Educ Couns. 2008 Sep;72(3):374-81
pubmed: 18656322
Med Educ Online. 2015 Feb 03;20:25923
pubmed: 25652117
J Surg Educ. 2016 Nov - Dec;73(6):e118-e130
pubmed: 27886971
J Womens Health (Larchmt). 2014 Jun;23(6):481-4
pubmed: 24844292
JAMA Intern Med. 2017 May 1;177(5):651-657
pubmed: 28264090
Acad Med. 2016 Aug;91(8):1068-73
pubmed: 27276007
JAMA Intern Med. 2016 Sep 1;176(9):1294-304
pubmed: 27400435
J Surg Educ. 2013 Nov-Dec;70(6):703-8
pubmed: 24209644
Ann Thorac Surg. 2017 Sep;104(3):1062-1068
pubmed: 28760467
J Womens Health (Larchmt). 2017 May;26(5):413-419
pubmed: 28437214
J Womens Health (Larchmt). 2017 May;26(5):560-570
pubmed: 28281870