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Lund S, Griffeth EM, Williamson A, Collings A, Gudmundsdottir H, Han A, Kearse L, Kratzke IM, Wilkins P, Prokop LJ, Cook DA. Gender Differences in Autonomy Granted to Residents and Fellows During Procedural Training: A Systematic Review and Meta-Analysis. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2024; 99:922-930. [PMID: 38412483 DOI: 10.1097/acm.0000000000005673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/29/2024]
Abstract
PURPOSE Supervisors may be prone to implicit (unintentional) bias when granting procedural autonomy to trainees due to the subjectivity of autonomy decisions. The authors aimed to conduct a systematic review and meta-analysis to assess the differences in perceptions of procedural autonomy granted to physician trainees based on gender and/or race. METHOD MEDLINE, Embase, CENTRAL, Scopus, and Web of Science were searched (search date: January 5, 2022) for studies reporting quantitative gender- or race-based differences in perceptions of procedural autonomy of physician trainees. Reviewers worked in duplicate for article selection and data abstraction. Primary measures of interest were self-reported and observer-rated procedural autonomy. Meta-analysis pooled differences in perceptions of procedural autonomy based on trainee gender. RESULTS The search returned 2,714 articles, of which 16 were eligible for inclusion. These reported data for 6,109 trainees (median, 90 per study) and 2,763 supervisors (median, 54 per study). No studies investigated differences in perceptions of autonomy based on race. In meta-analysis of disparities between genders in autonomy ratings (positive number favoring female trainees), pooled standardized mean differences were -0.12 (95% confidence interval [CI], -0.19 to -0.04; P = .003; n = 10 studies) for trainee self-rated autonomy and -0.05 (95% CI, -0.11 to 0.01; P = .07; n = 9 studies) for supervisor ratings of autonomy. CONCLUSIONS Limited evidence suggests that female trainees perceived that they received less procedural autonomy than did males. Further research exploring the degree of gender- and race-based differences in procedural autonomy, and factors that influence these differences is warranted.
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Schaefer EJ, Thayer MK, Colon AF, Sanghavi KK, Sears ED, Giladi AM, Katz RD. Video-Based Assessment of Microsurgical Trainees: An Evaluation of Gender Bias. J Reconstr Microsurg 2024; 40:371-378. [PMID: 37751884 DOI: 10.1055/a-2181-6921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/28/2023]
Abstract
BACKGROUND Gender bias in graduate medical evaluations remains a challenging issue. This study evaluates implicit gender bias in video-based evaluations of microsurgical technique, which has not previously been described in the literature. METHODS Two videos were recorded of microsurgical anastomosis; the first was performed by a hand/microsurgery fellow and the second by an expert microsurgeon. A total of 150 surgeons with microsurgical experience were recruited to evaluate the videos; they were told these videos depicted a surgical trainee 1 month into fellowship followed by the same trainee 10 months later. The only variable was the name ("Rachel" or "David") that each participant was randomly assigned to evaluate. Participants were asked to score each video for quality, technique, efficiency, as well as overall progression and development after the second video compared with the initial video. To focus on bias, these outcome measures were selected to be purposefully subjective and all ratings were based on a subjective 1to 10 scale (10 = excellent). RESULTS The analysis included 150 participants (75% male). There were no statistically significant differences in scores between the "female" and "male" trainee. The trainees received the same median initial (1-month video) and final (11th-month video) scores for all criteria except initial technique, in which the female trainee received a 7 and the male trainee received an 8. Notably, 11-month scores were consistently the same or lower than 1-month scores for both study groups (p < 0.001). There were also no differences within either study group based on participant sex. Microsurgery practitioners overall rated both groups lower than those who do not currently practice microsurgery. CONCLUSION Our study did not identify a gender bias in this evaluation method. Further investigation into how we assess and grade trainees as well as the presence and impact of implicit biases on varying surgical assessment methods is warranted.
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Affiliation(s)
- Eliana J Schaefer
- The Curtis National Hand Center, MedStar Union Memorial Hospital, Baltimore, Maryland
- Georgetown University School of Medicine, Washington, District of Columbia
| | - Mary K Thayer
- The Curtis National Hand Center, MedStar Union Memorial Hospital, Baltimore, Maryland
| | - Anthony F Colon
- The Curtis National Hand Center, MedStar Union Memorial Hospital, Baltimore, Maryland
| | - Kavya K Sanghavi
- The Curtis National Hand Center, MedStar Union Memorial Hospital, Baltimore, Maryland
| | - Erika D Sears
- Section of Plastic Surgery, University of Michigan, Ann Arbor, Michigan
- VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan
| | - Aviram M Giladi
- The Curtis National Hand Center, MedStar Union Memorial Hospital, Baltimore, Maryland
| | - Ryan D Katz
- The Curtis National Hand Center, MedStar Union Memorial Hospital, Baltimore, Maryland
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García-Vega C, Carbonell Morote S, Villodre Tudela C, Viñas Martinez T, Ramia JM. Gender gap in the general surgery residence. Cir Esp 2024; 102:230-232. [PMID: 38373615 DOI: 10.1016/j.cireng.2023.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Accepted: 12/17/2023] [Indexed: 02/21/2024]
Affiliation(s)
- Celia García-Vega
- Servicio de Cirugía General y del Aparato Digestivo, Hospital General Universitario Dr. Balmis, Alicante, Spain.
| | - Silvia Carbonell Morote
- Servicio de Cirugía General y del Aparato Digestivo, Hospital General Universitario Dr. Balmis, Alicante, Spain
| | - Celia Villodre Tudela
- Servicio de Cirugía General y del Aparato Digestivo, Hospital General Universitario Dr. Balmis, Alicante, Spain
| | - Tamara Viñas Martinez
- Servicio de Cirugía General y del Aparato Digestivo, Hospital General Universitario Dr. Balmis, Alicante, Spain
| | - José Manuel Ramia
- Servicio de Cirugía General y del Aparato Digestivo, Hospital General Universitario Dr. Balmis, Alicante, Spain
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Poljo A, Sortino R, Daume D, Probst P, Billeter AT, Müller-Stich BP, Klasen JM. Educational challenges and opportunities for the future generation of surgeons: a scoping review. Langenbecks Arch Surg 2024; 409:82. [PMID: 38433154 DOI: 10.1007/s00423-024-03270-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Accepted: 02/22/2024] [Indexed: 03/05/2024]
Abstract
PURPOSE Surgery offers exciting opportunities but comes with demanding challenges that require attention from both surgical program administrators and aspiring surgeons. The hashtag #NoTrainingTodayNoSurgeonsTomorrow on 𝕏 (previously Twitter) underscores the importance of ongoing training. Our scoping review identifies educational challenges and opportunities for the next generation of surgeons, analyzing existing studies and filling gaps in the literature. METHODS Following the PRISMA guidelines, MEDLINE/PubMed was searched in February 2022, using the MeSH terms "surgeons/education," for articles in English or German on general, abdominal, thoracic, vascular, and hand surgery and traumatology targeting medical students, surgical residents, future surgeons, and fellows. RESULTS The initial search yielded 1448 results. After a step-by-step evaluation process, 32 publications remained for complete review. Three main topics emerged: surgical innovations and training (n = 7), surgical culture and environment (n = 19), and mentoring (n = 6). The articles focusing on surgical innovations and training mainly described the incorporation of structured surgical training methods and program initiatives. Articles on surgical culture examined residents' burnout, well-being, and gender issues. Challenges faced by women, including implicit bias and sexual harassment, were highlighted. Regarding mentoring, mentees' needs, training challenges, and the qualities expected of both mentors and mentees were addressed. CONCLUSION At a time of COVID-19-driven surgical innovations, the educational and working environment of the new generation of surgeons is changing. Robotic technology and other innovations require future surgeons to acquire additional technological and digital expertise. With regard to the cultural aspects of training, surgery needs to adapt curricula to meet the demands of the new generation of surgeons, but even more it has to transform its culture.
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Affiliation(s)
- Adisa Poljo
- Department of Visceral Surgery, Clarunis - University Digestive Healthcare Center Basel, University Hospital Basel and St. Clara Hospital, Basel, Switzerland
| | - Rosita Sortino
- Department of Visceral Surgery, Clarunis - University Digestive Healthcare Center Basel, University Hospital Basel and St. Clara Hospital, Basel, Switzerland
| | - Diana Daume
- Department of Surgery, Lucerne Cantonal Hospital, Spitalstrasse, 6000, Lucerne, Switzerland
| | - Pascal Probst
- Department of Surgery, Cantonal Hospital Thurgau, 8501, Frauenfeld, Switzerland
| | - Adrian T Billeter
- Department of Visceral Surgery, Clarunis - University Digestive Healthcare Center Basel, University Hospital Basel and St. Clara Hospital, Basel, Switzerland
| | - Beat P Müller-Stich
- Department of Visceral Surgery, Clarunis - University Digestive Healthcare Center Basel, University Hospital Basel and St. Clara Hospital, Basel, Switzerland
| | - Jennifer M Klasen
- Department of Visceral Surgery, Clarunis - University Digestive Healthcare Center Basel, University Hospital Basel and St. Clara Hospital, Basel, Switzerland.
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Sevestre A, Dochez V, Souron R, Deschamps T, Winer N, Thubert T. Evaluation Tools for Assessing Autonomy of Surgical Residents in the Operating Room and Factors Influencing Access to Autonomy: A Systematic Literature Review. JOURNAL OF SURGICAL EDUCATION 2024; 81:182-192. [PMID: 38160113 DOI: 10.1016/j.jsurg.2023.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 10/16/2023] [Accepted: 11/01/2023] [Indexed: 01/03/2024]
Abstract
BACKGROUND Surgical residents in France lack a clear pedagogical framework for achieving autonomy in the operating room. The progressive acquisition of surgical autonomy is a determining factor in the confidence of operators for their future independent practice. Currently, there is no autonomy scale commonly used in Europe. The objective of this study is to identify existing tools for quantifying the autonomy of residents and the factors that influence it. MATERIALS AND METHODS We conducted a qualitative systematic review following the recommendations of the Systematic Review Without Meta-Analysis (SWiM) guidelines. Publications were extracted from the MEDLINE (PubMed), EMBASE, and PSYCINFO databases. All publications without date restrictions up to July 2022 were identified. RESULTS Among the 231 identified publications, 21 met the inclusion criteria. Seventeen publications used a graded autonomy assessment tool by the student and/or the teacher, while 4 used evaluations by an observing third party. We found 8 different autonomy scales, with the Zwisch Scale representing 57.1% of the cases. Factors influencing autonomy were diverse, including the work context, experience, and gender of the resident and their teacher. DISCUSSION We found heterogeneity in the tools used to "measure" the autonomy of a resident in the operating room. The SIMPL tool or the Zwisch Scale appear to be the most frequently used tools. The relationship between autonomy, performance, confidence, and knowledge may require multidimensional tools that encompass various areas of competence, but this could make their daily application more challenging. The factors influencing autonomy are numerous; and understanding them would improve teaching in the operating room. There is a significant lack of data on surgical autonomy in France, as well as a lack of evaluation in the field of gynecology-obstetrics worldwide.
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Affiliation(s)
- Anaïs Sevestre
- Nantes Université, CHU Nantes, Service de Gynécologie-Obstétrique, Nantes, France; Nantes Université, CHU Nantes, Movement - Interactions - Performance, Nantes, France
| | - Vincent Dochez
- Nantes Université, CHU Nantes, Service de Gynécologie-Obstétrique, Nantes, France; Nantes Université, CHU Nantes, Movement - Interactions - Performance, Nantes, France.
| | - Robin Souron
- Nantes Université, CHU Nantes, Movement - Interactions - Performance, Nantes, France
| | - Thibault Deschamps
- Nantes Université, CHU Nantes, Movement - Interactions - Performance, Nantes, France
| | - Norbert Winer
- Nantes Université, CHU Nantes, Service de Gynécologie-Obstétrique, Nantes, France; Nantes Université, CHU Nantes, INRAE, Nantes, France
| | - Thibault Thubert
- Nantes Université, CHU Nantes, Service de Gynécologie-Obstétrique, Nantes, France; Nantes Université, CHU Nantes, Movement - Interactions - Performance, Nantes, France
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Chang AJ, Kwon CM, Shabahang MM, Factor M, Rapp M, Hoffman RL. Sex influences how attendings evaluate surgical residents in the operating room. Am J Surg 2024; 227:127-131. [PMID: 37858373 DOI: 10.1016/j.amjsurg.2023.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 08/31/2023] [Accepted: 10/02/2023] [Indexed: 10/21/2023]
Abstract
BACKGROUND The aim of this study was to evaluate the influence of sex on facultys' perception of resident autonomy and performance. METHODS Autonomy/performance/complexity evaluations performed by faculty of categorical general surgery residents (2015-2021) were analyzed. Comparisons of scores by faculty and resident sex were performed. RESULTS A total of 10967 paper/electronic evaluations were collected. Female attendings rated female residents significantly lower in autonomy when compared to males (2.75 vs 2.91, p = 0.0037). There was no significant difference in autonomy ratings for male versus female residents when evaluated by a male attending (2.93 vs 2.96, p = 0.054) but male attendings did rate female residents significantly lower in autonomy at the highest complexities (2.37 vs 2.50, p = 0.012). CONCLUSION The data suggests a unique interaction between attending and resident sex. A periodic evaluation of evaluations within one's program may provide invaluable implicit bias insight and should be considered.
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Affiliation(s)
- Alvin J Chang
- Department of General Surgery, Geisinger Medical Center, 100 N. Academy Ave, Danville, PA, 17822, USA.
| | - Catherine M Kwon
- Department of General Surgery, Geisinger Medical Center, 100 N. Academy Ave, Danville, PA, 17822, USA
| | - Mohsen M Shabahang
- Department of General Surgery, WellSpan York Hospital, 1001 S George St, York, PA, 17403, USA.
| | - Matthew Factor
- Department of General Surgery, Geisinger Medical Center, 100 N. Academy Ave, Danville, PA, 17822, USA
| | - Megan Rapp
- Department of General Surgery, Geisinger Medical Center, 100 N. Academy Ave, Danville, PA, 17822, USA
| | - Rebecca L Hoffman
- Department of General Surgery, Geisinger Medical Center, 100 N. Academy Ave, Danville, PA, 17822, USA
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Biller J, Simunich T, Morrissey S, Dumire R. Evaluation of Gender Bias Through Autonomy During Laparoscopic Cholecystectomy at a Rural Community General Surgery Residency Program. JOURNAL OF SURGICAL EDUCATION 2023; 80:1508-1515. [PMID: 37353421 DOI: 10.1016/j.jsurg.2023.05.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 05/10/2023] [Accepted: 05/21/2023] [Indexed: 06/25/2023]
Abstract
OBJECTIVE Gender bias not only continues to exist in surgical specialties, but in the medical field overall. Despite females graduating from medical schools at the same rate as men, a discrepancy still exists in the number of females pursuing surgical specialties compared to their male counterparts. We hypothesized that surgical training occurring in smaller institutions with close-knit relationships between faculty and residents should decrease the likelihood of gender bias towards females, as measured by perceived autonomy during laparoscopic cholecystectomy. DESIGN All 17 surgery residents at a community surgery residency program were asked to voluntarily and anonymously complete an investigator-created questionnaire after every laparoscopic cholecystectomy from October 2020 to May 2022. The questionnaire included details regarding overall resident operative experience, case complexity, patient diagnosis, resident autonomy throughout the case, and perceived autonomy compared to their peers. Each respondent estimated their percent autonomy from 0% to 100% during 5 distinct portions of the case, from which, a mean overall percent autonomy was calculated. RESULTS A total of 233 questionnaires (98 female, 135 male) were completed during the study period, with 8 females and 9 males in the first study year and 7 females and 10 males in the second. Mean overall autonomy was statistically similar between males and females, 71% and 72% respectively (p = 0.967). Case difficulty was not statistically different between males and females (p = 0.445). There was a significant difference in autonomy of all residents with male and female attendings, 67.5% and 80.3%, respectively (p = 0.001), however this did not differ between male and female residents. Eighty-three percent of respondents felt that their level of autonomy was acceptable for their postgraduate year (PGY) level. Over 90 percent of respondents felt their autonomy was not affected by their gender. CONCLUSIONS There was no significant difference in perceived autonomy between male and female residents during laparoscopic cholecystectomy at our small general surgery residency program. Gender bias did not appear to be a prohibiting factor in the amount of autonomy given to male and female residents.
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Affiliation(s)
- Jessica Biller
- Department of Surgery, Conemaugh Memorial Medical Center, Johnstown, Pennsylvania.
| | - Thomas Simunich
- Department of Research, Duke LifePoint Conemaugh Memorial Medical Center, Johnstown, Pennsylvania
| | - Shawna Morrissey
- Department of Surgery, Conemaugh Memorial Medical Center, Johnstown, Pennsylvania
| | - Russell Dumire
- Department of Surgery, Conemaugh Memorial Medical Center, Johnstown, Pennsylvania
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Gates RS, Marcotte K, Moreci R, George BC, Kim GJ, Kraft KH, Soltani T, Ötleş E, Krumm AE. Association of Gender and Operative Feedback Quality in Surgical Residents. JOURNAL OF SURGICAL EDUCATION 2023; 80:1516-1521. [PMID: 37385931 DOI: 10.1016/j.jsurg.2023.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 05/12/2023] [Accepted: 06/02/2023] [Indexed: 07/01/2023]
Abstract
OBJECTIVE Feedback is critical for learning, however, gender differences exist in the quality of feedback that trainees receive. For example, narrative feedback on surgical trainees' end-of-block rotations differs based on trainee-faculty gender dyads, with female faculty giving higher quality feedback and male trainees receiving higher quality feedback. Though this represents evidence of gender bias in global evaluations, there is limited understanding of how much bias might be present in operative workplace-based assessments (WBAs). In this study, we explore the quality of narrative feedback among trainee-faculty gender dyads in an operative WBA. DESIGN A previously validated natural language processing model was used to examine instances of narrative feedback and assign a probability of being characterized as high quality feedback (defined as feedback which was relevant as well as corrective and/or specific). A linear mixed model was performed, with probability of high quality feedback as the outcome, and resident gender, faculty gender, PGY, case complexity, autonomy rating, and operative performance rating as explanatory variables. PARTICIPANTS Analyses included 67,434 SIMPL operative performance evaluations (2,319 general surgery residents, 70 institutions) collected from September 2015 through September 2021. RESULTS Of 36.3% evaluations included narrative feedback. Male faculty were more likely to provide narrative feedback compared to female faculty. Mean probabilities of receiving high quality feedback ranged from 81.6 (female faculty-male resident) to 84.7 (male faculty-female resident). Model-based results demonstrated that female residents were more likely to receive high quality feedback (p < 0.01), however, there was no significant difference in probability of high quality narrative feedback based on faculty-resident gender dyad (p = 0.77). CONCLUSIONS Our study revealed resident gender differences in the probability of receiving high-quality narrative feedback following a general surgery operation. However, we found no significant differences based on faculty-resident gender dyad. Male faculty were more likely to provide narrative feedback compared to their female colleagues. Further research using general surgery resident-specific feedback quality models may be warranted.
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Affiliation(s)
- Rebecca S Gates
- Center for Surgical Training and Research, Department of Surgery, University of Michigan, Ann Arbor, Michigan.
| | - Kayla Marcotte
- Center for Surgical Training and Research, Department of Surgery, University of Michigan, Ann Arbor, Michigan; University of Michigan Medical School, Ann Arbor, Michigan; Department of Learning Health Sciences, University of Michigan, Ann Arbor, Michigan
| | - Rebecca Moreci
- Center for Surgical Training and Research, Department of Surgery, University of Michigan, Ann Arbor, Michigan
| | - Brian C George
- Center for Surgical Training and Research, Department of Surgery, University of Michigan, Ann Arbor, Michigan; Department of Learning Health Sciences, University of Michigan, Ann Arbor, Michigan; Department of Surgery, University of Michigan, Ann Arbor, Michigan
| | - Grace J Kim
- Center for Surgical Training and Research, Department of Surgery, University of Michigan, Ann Arbor, Michigan; Department of Surgery, University of Michigan, Ann Arbor, Michigan
| | - Kate H Kraft
- Center for Surgical Training and Research, Department of Surgery, University of Michigan, Ann Arbor, Michigan; Department of Urology, University of Michigan, Ann Arbor, Michigan
| | - Tandis Soltani
- Center for Surgical Training and Research, Department of Surgery, University of Michigan, Ann Arbor, Michigan; Department of Surgery, University of Michigan, Ann Arbor, Michigan
| | - Erkin Ötleş
- University of Michigan Medical School, Ann Arbor, Michigan
| | - Andrew E Krumm
- Center for Surgical Training and Research, Department of Surgery, University of Michigan, Ann Arbor, Michigan; University of Michigan Medical School, Ann Arbor, Michigan; Department of Learning Health Sciences, University of Michigan, Ann Arbor, Michigan
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Baragada S, Petree B, Tee M, Frankova D, Raman S, Franko J. Differences in Resident Self-Evaluation and Clinical Competency Committee Evaluation Using ACGME Milestone Versions 1.0 and 2.0. JOURNAL OF SURGICAL EDUCATION 2023; 80:1378-1384. [PMID: 37573192 DOI: 10.1016/j.jsurg.2023.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Revised: 06/09/2023] [Accepted: 07/05/2023] [Indexed: 08/14/2023]
Abstract
OBJECTIVE Intentionally self-driven professional development of surgical resident physicians is a hallmark of surgical training and is expected to gain further traction as Entrustable Professional Activities (EPAs) become the new paradigm for surgical education. We aimed to analyze how surgical residents rate themselves as compared to the evaluation of the Clinical Competency Committee using ACGME Milestones Version 1 (M1.0) and Version 2 (M2.0). DESIGN We asked 22 general surgical trainees for self-evaluation of Milestones (both M1.0 and M2.0) from 2017 semiannually to 2022. ACGME-required Milestone evaluations by the Clinical Competency Committee (CCC) were independently performed after the time window for resident self-evaluation. Neither trainees nor CCC were aware of the other party's evaluations. There were 1552 paired data available for evaluating individual competencies by both trainees and CCC. Paired Wilcoxon signed-rank tests were then performed among the corresponding pairs. SETTING MercyOne Des Moines Medical Center, Des Moines, IA; Teaching tertiary referral center. PARTICIPANTS Twenty-two general surgical trainees at this hospital and 28 faculty surgeons participated in this study. RESULTS The average self-evaluation of surgical residents was lower in the M1.0 cohort compared to the corresponding CCC evaluation (1.96 ± 0.72 vs. 2.11 ± 0.67; p < 0.001). M1.0 self-assessments and CCC-assessments were statistically similar for ICS (p = 0.548) and PROF (p = 0.554) competencies and differed for MK (p < 0.001), PBLI (p < 0.001), PC (p < 0.001), SBP (p = 0.008). On the contrary, the M2.0 cohort demonstrated higher average self-evaluation of surgical residents compared to the corresponding CCC evaluation (2.75 ± 0.87 vs. 2.12 ± 0.97; p < 0.001). Significant differences were observed for all 6 ACGME competencies using M2.0 self-assessments and CCC-assessments (all p < 0.001). Multivariate regression modeling (p < 0.001, R2 = 0.255) predicted the degree of discordance between self-assessment and CCC-assessed achievement of competencies with a significant effect of gender (baseline male: coef = -0.232, p < 0.001), PGY level (-0.083 per year, p < 0.001) and Milestone version (0.831, p < 0.001). A significant interaction exists for all gender/Milestone combinations except for the female trainees with M1.0. CONCLUSIONS The difference between self-evaluated Milestone achievement and faculty-driven CCC evaluation of surgical resident physician performance is more evident in Milestones 2.0 than in Milestones 1.0. Residents self-evaluate higher compared to faculty using Milestones 2.0. This discrepancy is seen among both genders and is more pronounced among male residents overestimating core competencies with M2.0 self-evaluation than formal CCC assessment.
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Affiliation(s)
- Savitha Baragada
- MercyOne Medical Center, General Surgery Residency, Des Moines, Iowa
| | - Brandon Petree
- MercyOne Medical Center, General Surgery Residency, Des Moines, Iowa
| | - May Tee
- MercyOne Medical Center, General Surgery Residency, Des Moines, Iowa; Department of Surgery, Howard University College of Medicine, Washington, DC
| | - Daniela Frankova
- MercyOne Medical Center, General Surgery Residency, Des Moines, Iowa; Department of Clinical Medicine, Des Moines University College of Osteopathic Medicine, Des Moines, Iowa
| | - Shankar Raman
- MercyOne Medical Center, General Surgery Residency, Des Moines, Iowa
| | - Jan Franko
- MercyOne Medical Center, General Surgery Residency, Des Moines, Iowa.
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Ofshteyn A, Steinhagen E. Surgical Education: Disparities in Education May Impact the Quality and Likelihood of Completion of Training. Clin Colon Rectal Surg 2023; 36:315-320. [PMID: 37564350 PMCID: PMC10411215 DOI: 10.1055/s-0043-1763519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/12/2023]
Abstract
Female surgical trainees experience bias that begins at the preclinical stages of medical school, extending into their surgery clerkships, and then into their residency training. There are important implications in terms of training opportunities and career advancement, mentorship, sponsorship, and ultimately burnout. Childbearing and lactation also impact the experiences and perceptions of female trainees who have children. There are limited interventions that have improved the experience of women in surgical training. Mentorship appears to play an important role in ameliorating some of the negative consequences of the training environment and improving outcomes for women surgeons.
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Affiliation(s)
- Asya Ofshteyn
- Division of Colon and Rectal Surgery, Department of Surgery, Mayo Clinic, Rochester, Minnesota
| | - Emily Steinhagen
- Division of Colorectal, Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio
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Helliwell LA, Hyland CJ, Gonte MR, Malapati SH, Bain PA, Ranganathan K, Pusic AL. Bias in Surgical Residency Evaluations: A Scoping Review. JOURNAL OF SURGICAL EDUCATION 2023; 80:922-947. [PMID: 37142488 DOI: 10.1016/j.jsurg.2023.04.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 03/21/2023] [Accepted: 04/13/2023] [Indexed: 05/06/2023]
Abstract
OBJECTIVE Given widespread disparities in the surgical workforce and the advent of competency-based training models that rely on objective evaluations of resident performance, this review aims to describe the landscape of bias in the evaluation methods of residents in surgical training programs in the United States. DESIGN A scoping review was conducted within PubMed, Embase, Web of Science, and ERIC in May 2022, without a date restriction. Studies were screened and reviewed in duplicate by 3 reviewers. Data were described descriptively. SETTING/PARTICIPANTS English-language studies conducted in the United States that assessed bias in the evaluation of surgical residents were included. RESULTS The search yielded 1641 studies, of which 53 met inclusion criteria. Of the included studies, 26 (49.1%) were retrospective cohort studies, 25 (47.2%) were cross-sectional studies, and 2 (3.8%) were prospective cohort studies. The majority included general surgery residents (n = 30, 56.6%) and nonstandardized examination modalities (n = 38, 71.7%), such as video-based skills evaluations (n = 5, 13.2%). The most common performance metric evaluated was operative skill (n = 22, 41.5%). Overall, the majority of studies demonstrated bias (n = 38, 73.6%) and most investigated gender bias (n = 46, 86.8%). Most studies reported disadvantages for female trainees regarding standardized examinations (80.0%), self-evaluations (73.7%), and program-level evaluations (71.4%). Four studies (7.6%) assessed racial bias, of which all reported disadvantages for trainees underrepresented in surgery. CONCLUSIONS Evaluation methods for surgery residents may be prone to bias, particularly with regard to female trainees. Research is warranted regarding other implicit and explicit biases, such as racial bias, as well as for nongeneral surgery subspecialties.
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Affiliation(s)
| | | | - Madeleine R Gonte
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts; Wayne State University School of Medicine, Detroit, Michigan
| | | | - Paul A Bain
- Countway Library, Harvard Medical School, Boston, Massachusetts
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Filiberto AC, Abbott KL, Shickel B, George BC, Cochran AL, Sarosi GA, Upchurch GR, Loftus TJ. Resident Operative Autonomy and Attending Verbal Feedback Differ by Resident and Attending Gender. ANNALS OF SURGERY OPEN 2023; 4:e256. [PMID: 37600892 PMCID: PMC10431433 DOI: 10.1097/as9.0000000000000256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 01/02/2023] [Indexed: 02/05/2023] Open
Abstract
Objectives This study tests the null hypotheses that overall sentiment and gendered words in verbal feedback and resident operative autonomy relative to performance are similar for female and male residents. Background Female and male surgical residents may experience training differently, affecting the quality of learning and graduated autonomy. Methods A longitudinal, observational study using a Society for Improving Medical Professional Learning collaborative dataset describing resident and attending evaluations of resident operative performance and autonomy and recordings of verbal feedback from attendings from surgical procedures performed at 54 US general surgery residency training programs from 2016 to 2021. Overall sentiment, adjectives, and gendered words in verbal feedback were quantified by natural language processing. Resident operative autonomy and performance, as evaluated by attendings, were reported on 5-point ordinal scales. Performance-adjusted autonomy was calculated as autonomy minus performance. Results The final dataset included objective assessments and dictated feedback for 2683 surgical procedures. Sentiment scores were higher for female residents (95 [interquartile range (IQR), 4-100] vs 86 [IQR 2-100]; P < 0.001). Gendered words were present in a greater proportion of dictations for female residents (29% vs 25%; P = 0.04) due to male attendings disproportionately using male-associated words in feedback for female residents (28% vs 23%; P = 0.01). Overall, attendings reported that male residents received greater performance-adjusted autonomy compared with female residents (P < 0.001). Conclusions Sentiment and gendered words in verbal feedback and performance-adjusted operative autonomy differed for female and male general surgery residents. These findings suggest a need to ensure that trainees are given appropriate and equitable operative autonomy and feedback.
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Affiliation(s)
- Amanda C. Filiberto
- From the Department of Surgery, University of Florida Health, Gainesville, FL
| | - Kenneth L. Abbott
- From the Department of Surgery, University of Florida Health, Gainesville, FL
| | - Benjamin Shickel
- Department of Medicine, University of Florida Health, Gainesville, FL
| | - Brian C. George
- Department of Learning Health Sciences, University of Michigan, Ann Arbor, MI
| | - Amalia L. Cochran
- From the Department of Surgery, University of Florida Health, Gainesville, FL
| | - George A. Sarosi
- From the Department of Surgery, University of Florida Health, Gainesville, FL
| | - Gilbert R. Upchurch
- From the Department of Surgery, University of Florida Health, Gainesville, FL
| | - Tyler J. Loftus
- From the Department of Surgery, University of Florida Health, Gainesville, FL
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13
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Anderson JE, Zern NK, Calhoun KE, Wood DE, Smith CA. Assessment of Potential Gender Bias in General Surgery Resident Milestone Evaluations. JAMA Surg 2022; 157:1164-1166. [PMID: 36223104 PMCID: PMC9557830 DOI: 10.1001/jamasurg.2022.3929] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Accepted: 06/23/2022] [Indexed: 01/11/2023]
Abstract
This quality improvement study uses Accreditation Council for Graduate Medical Education Milestone evaluation scores to compare the scores of men and women surgical residents.
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Affiliation(s)
| | - Nicole K. Zern
- Department of Surgery, University of Washington, Seattle
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14
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Sobol DL, Berfield KS, Shalhub S, Tatum RP, Yale LA, Perkins JD, Calhoun KE. Exploring the Influence of Gender on Surgical Clerkship Grades and Test Scores: A Single Institution, Multisite Comparison. JOURNAL OF SURGICAL EDUCATION 2022; 79:1132-1139. [PMID: 35660307 DOI: 10.1016/j.jsurg.2022.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 04/23/2022] [Accepted: 05/11/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVE General surgery remains a male-dominated specialty. Women constitute 54% of medical students at the University of Washington, but only 3.4% of full professors within the Department of Surgery. Many believe surgical attrition and "the leaky pipeline" starts during medical school clerkships, but the exact deterrents remain undefined. This study examined the impact of gender on grading during the third-year surgical clerkship. DESIGN Retrospective analysis of confidential final clerkship grades, examination scores and subjective clerkship grades was conducted. These were compared by gender, time period, and type of clerkship site. Chi-square analyses were performed. SETTING Clerkship sites across multiple academic (n = 6) and nonacademic (n = 14) locations. PARTICIPANTS All third-year medical students undergoing a core surgical clerkship over 2 time periods-2007 to 2010 (period 1) and 2016 to 2019 (period 2)-were included. RESULTS There were 539 medical students in period 1 and 792 in period 2. The percentage of women was stable over time (52.0% vs 54.2%, p = 0.43). Final clerkship grades of Honors increased significantly from period 1 to 2 (22.3% vs 44.3%, p < 0.0001) and was similarly distributed by gender (women: 21.4% vs 48.0%, p < 0.0001; men 23.2% vs 39.9%, p < 0.0001). Honors on examinations remained stable over time and did not differ by gender. Women earned more final clerkship honors than men at academic sites in period 2 (48.4% vs 30.9%, p < 0.001). This finding was not identified in period 1, nor at nonacademic sites. CONCLUSION There was a significant increase in surgical clerkship honors over the past decade, independent of gender. Women attained more clinical and final clerkship honors than men and similar exam grades as time progressed, suggesting that gender bias in the subjective grading of women at this institution does not directly contribute to the loss of talented women as they progress from medical student to faculty within the department, with said gender imbalance not related to clerkship evaluations.
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Affiliation(s)
- Danielle L Sobol
- University of Washington School of Medicine, Seattle, Washington
| | | | - Sherene Shalhub
- University of Washington School of Medicine, Seattle, Washington
| | - Roger P Tatum
- University of Washington School of Medicine, Seattle, Washington
| | - Laura A Yale
- University of Washington School of Medicine, Seattle, Washington
| | - James D Perkins
- University of Washington School of Medicine, Seattle, Washington
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15
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Early Barriers to Career Progression of Women in Surgery and Solutions to Improve Them: A Systematic Scoping Review. Ann Surg 2022; 276:246-255. [PMID: 35797642 DOI: 10.1097/sla.0000000000005510] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE This study aims to summarize the evidence concerning the barriers that exist to the career progression of women in surgery and to provide potential solutions to overcome these obstacles. BACKGROUND Visible and invisible impediments can hinder female doctors' pursuit of a surgical career, from choosing a surgical specialty to training opportunities and all the way through career progression. METHODS Database search of original studies about barriers for female surgeons during choice of surgical career, residency, and career progression. A query including possible solutions such as mentorship and network was included. RESULTS Of 4618 total articles; 4497 were excluded as duplicates, having incorrect study focus, or not being original studies; leaving 120 studies meeting the inclusion criteria. Of the articles included, 22 (18%) focused on factors affecting the pursuit of a surgical career, such as surgical work hours and limited time for outside interests, 55 (46%) analyzed the main barriers that exist during surgical residency and fellowship training, such as discrimination and sexual harassment, 27 (23%) focused on barriers to career advancement, heavy workloads, ineffective mentorship, unclear expectations for advancement, inequality in pay or work-home conflicts. Among studies reporting on possible solutions, 8 (6.5%) articles reported on the role of effective mentorship to support career advancement and to provide moral support and 8 (6.5%) on the emerging role of social media for networking. Our analysis showed how different impediments hinder surgical career progression for women, with notable consequences on burnout and attrition. CONCLUSIONS Identification and recognition of obstacles to career progression is the first step to addressing the gender gap in surgery. Active strategies should be improved to promote a culture of diversity and to create equal opportunity for women in surgery, while implementing structured mentoring programs and investing on an adequate communication on social media to engage the future generations.
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16
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Swanberg M, Woodson-Smith S, Pangaro L, Torre D, Maggio L. Factors and Interactions Influencing Direct Observation: A Literature Review Guided by Activity Theory. TEACHING AND LEARNING IN MEDICINE 2022; 34:155-166. [PMID: 34238091 DOI: 10.1080/10401334.2021.1931871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 04/19/2021] [Accepted: 05/11/2021] [Indexed: 06/13/2023]
Abstract
PhenomenonEnsuring that future physicians are competent to practice medicine is necessary for high quality patient care and safety. The shift toward competency-based education has placed renewed emphasis on direct observation via workplace-based assessments in authentic patient care contexts. Despite this interest and multiple studies focused on improving direct observation, challenges regarding the objectivity of this assessment approach remain underexplored and unresolved. Approach: We conducted a literature review of direct observation in authentic patient contexts by systematically searching databases PubMed, Embase, Web of Science, and ERIC. Included studies comprised original research conducted in the patient care context with authentic patients, either as a live encounter or a video recording of an actual encounter, which focused on factors affecting the direct observation of undergraduate medical education (UME) or graduate medical education (GME) trainees. Because the patient care context adds factors that contribute to the cognitive load of the learner and of the clinician-observer we focused our question on such contexts, which are most useful in judgments about advancement to the next level of training or practice. We excluded articles or published abstracts not conducted in the patient care context (e.g., OSCEs) or those involving simulation, allied health professionals, or non-UME/GME trainees. We also excluded studies focused on end-of-rotation evaluations and in-training evaluation reports. We extracted key data from the studies and used Activity Theory as a lens to identify factors affecting these observations and the interactions between them. Activity Theory provides a framework to understand and analyze complex human activities, the systems in which people work, and the interactions or tensions between multiple associated factors. Findings: Nineteen articles were included in the analysis; 13 involved GME learners and 6 UME learners. Of the 19, six studies were set in the operating room and four in the Emergency department. Using Activity Theory, we discovered that while numerous studies focus on rater and tool influences, very few study the impact of social elements. These are the rules that govern how the activity happens, the environment and members of the community involved in the activity and how completion of the activity is divided up among the members of the community. Insights: Viewing direct observation via workplace-based assessment through the lens of Activity Theory may enable educators to implement curricular changes to improve direct observation of assessment. Activity Theory may allow researchers to design studies to focus on the identified underexplored interactions and influences in relation to direct observation.
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Affiliation(s)
- Margaret Swanberg
- Department of Neurology, Uniformed Services University, Bethesda, Maryland, USA
| | - Sarah Woodson-Smith
- Department of Neurology, Naval Medical Center Portsmouth, Portsmouth, Virginia, USA
| | - Louis Pangaro
- Department of Medicine, Uniformed Services University, Bethesda, Maryland, USA
| | - Dario Torre
- Department of Medicine, Uniformed Services University, Bethesda, Maryland, USA
- Center for Health Professions Education, Uniformed Services University, Bethesda, Maryland, USA
| | - Lauren Maggio
- Department of Medicine, Uniformed Services University, Bethesda, Maryland, USA
- Center for Health Professions Education, Uniformed Services University, Bethesda, Maryland, USA
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17
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Impact of Gender on Clinical Evaluation of Trainees in the Intensive Care Unit. ATS Sch 2021; 2:442-451. [PMID: 34667992 PMCID: PMC8518669 DOI: 10.34197/ats-scholar.2021-0048oc] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Accepted: 07/07/2021] [Indexed: 11/25/2022] Open
Abstract
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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18
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Smith CB, Saillant NN, Mendoza AE. Perceptions of differences in graduated autonomy between male and female surgical residents. Surgery 2021; 170:1281-1284. [PMID: 33775394 DOI: 10.1016/j.surg.2021.02.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 02/01/2021] [Indexed: 11/25/2022]
Affiliation(s)
- Charlotte B Smith
- University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC. https://twitter.com/cblythesmith
| | | | - April E Mendoza
- Department of Surgery, Massachusetts General Hospital, Boston, MA.
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19
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Elkbuli A, Ehrlich H, Gargano T, Newsome K, Liu H, McKenney M, Ang D. Operative Confidence Among U.S General Surgery Residents. Am Surg 2021:31348211038588. [PMID: 34384279 DOI: 10.1177/00031348211038588] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND General surgery residents (GSRs) must develop operative autonomy skills to practice independently after graduation. We aim to investigate perceived confidence and operative autonomy of GSR physicians in order to identify and address influential factors. METHODS A 28-question anonymous online survey was distributed to 23 United States general surgery residency programs. Multivariable logistic regression was used for calculating the adjusted odds ratio (aOR) for binary outcomes. Significance was defined as P-values ≤ .05 or 95% confidence intervals (CIs) >1 or <1. RESULTS There were 120/558 (21.5%) GSR respondents. General surgery residents with >200 overall operative case volume reported significantly higher confidence with minor cases (P = .05) and major cases (P = .02). General surgery residents that performed both minor and major surgeries reported higher confidence with minor cases at 85.7% compared to GSRs that performed mostly minor surgeries (64.7%) and mostly major surgeries (62.5%). General surgery residents who performed >50 minor surgeries during their PGY 1 and 2 were less confident with major cases than GSRs who performed <50 minor surgeries (aOR: 19.98, 95% CI: 1.26, 318). General surgery residents from community teaching hospitals reported higher confidence with major and minor cases than GSRs from university teaching hospitals and combined programs. CONCLUSION Increased case volume, predominant case type, early surgical experience during PGY 1 and 2 years, and training at community teaching hospitals were identified as the most important factors that positively influence perception of operative confidence and autonomy among GSRs. These may have important implications in the development of future surgeons.
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Affiliation(s)
- Adel Elkbuli
- Department of Surgery, Division of Trauma and Surgical Critical Care, 14506Kendall Regional Medical Center, Miami, FL, USA
| | - Haley Ehrlich
- Department of Surgery, Division of Trauma and Surgical Critical Care, 14506Kendall Regional Medical Center, Miami, FL, USA
| | - Toria Gargano
- Department of Surgery, Division of Trauma and Surgical Critical Care, 14506Kendall Regional Medical Center, Miami, FL, USA
| | - Kevin Newsome
- Department of Surgery, Division of Trauma and Surgical Critical Care, 14506Kendall Regional Medical Center, Miami, FL, USA
| | - Huazhi Liu
- Department of Surgery, 23703Ocala Regional Medical Center, Ocala, FL, USA
| | - Mark McKenney
- Department of Surgery, Division of Trauma and Surgical Critical Care, 14506Kendall Regional Medical Center, Miami, FL, USA.,Department of Surgery, University of South Florida, Tampa, FL, USA
| | - Darwin Ang
- Department of Surgery, 23703Ocala Regional Medical Center, Ocala, FL, USA.,Department of Surgery, University of Central Florida, Ocala, FL, USA
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20
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Ansari H, Pitt SC. #ILookLikeASurgeon: Or do I? The local and global impact of a hashtag. Am J Surg 2021; 221:908-909. [DOI: 10.1016/j.amjsurg.2020.10.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 10/14/2020] [Accepted: 10/15/2020] [Indexed: 10/23/2022]
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21
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Belvedere S, Joh D, Furlong T, Dennett E, Loveday BPT. Operative experience in essential emergency general surgery procedures: is autonomy achievable during surgical training? ANZ J Surg 2021; 91:1131-1137. [PMID: 33749971 DOI: 10.1111/ans.16730] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 02/22/2021] [Accepted: 02/23/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Readiness for practice is an ongoing concern in surgery. Surgeons who have completed general surgery training are expected to be proficient in performing common emergency procedures. The aim of this study was to assess the experience and autonomy of general surgery trainees in New Zealand in 10 emergency general surgery procedures, and identify factors associated with reaching primary operator (PO) thresholds. METHODS Operative logbook data from all New Zealand general surgery trainees from 2013 to 2017 were analysed. Data for 10 emergency general surgery procedures were extracted to determine PO and autonomous PO (mentor not scrubbed) rates. A threshold of 70% for PO and APO rates was used to define two levels of proficiency. RESULTS A total of 120 trainees performed 40 865 included procedures. Trainees met the PO threshold for all procedures by Surgical Education and Training (SET) 5. The APO threshold was met for three of 10 procedures (appendicectomy, drainage of perianal abscess and perforated peptic ulcer repair). Final APO rates for the other procedures ranged from 18% to 58%. On multivariate analysis, SET year and case volume were associated with increased odds of meeting the PO and APO thresholds. Female trainees were less likely to reach the PO and APO thresholds for three of 10 and four of 10 procedures, respectively. CONCLUSION Trainees had increasing PO and autonomous PO rates over the course of their training. Graduating New Zealand general surgeons likely have sufficient operative experience in emergency general surgery procedures. However, rates of autonomy are lower, and further research is needed to determine whether this affects readiness for independent practice.
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Affiliation(s)
- Shane Belvedere
- Department of Surgery, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Daniel Joh
- Department of Surgery, University of Auckland, Auckland, New Zealand
| | - Tim Furlong
- Department of Surgery, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Elizabeth Dennett
- Department of Surgery, Capital and Coast District Health Board, Wellington, New Zealand.,Department of Surgery and Anaesthesia, University of Otago, Wellington, New Zealand
| | - Benjamin P T Loveday
- Department of Surgery, Royal Melbourne Hospital, Melbourne, Victoria, Australia.,Department of Surgery, University of Auckland, Auckland, New Zealand.,Department of Surgical Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
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22
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Gender perception bias of operative autonomy evaluations among residents and faculty in general surgery training. Am J Surg 2020; 221:515-520. [PMID: 33189312 DOI: 10.1016/j.amjsurg.2020.11.016] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 10/21/2020] [Accepted: 11/05/2020] [Indexed: 11/23/2022]
Abstract
BACKGROUND Resident operative autonomy (ROA) is critical and a shared responsibility of both faculty and residents during training. We hypothesize that there is a perception of gender bias in residents' performance as evaluated by faculty and residents. METHOD Over a period of five academic years, between July 2014 and June 2019, ROA was evaluated using the Zwisch score. Reciprocal evaluations were completed by faculty and residents. RESULTS 39 surgeons (30 males, 9 females) and 42 residents (25 males, 15 females) completed 2360 evaluations (1180 by faculty, and a matched number by residents). PGY level was significantly associated with granting a higher level of autonomy. Gender of residents didn't affect the level of granted autonomy as evaluated by faculty. However, on self-evaluations, female residents rated their degree of autonomy lower than that of their male counterparts. CONCLUSION Gender did not influence the perception of autonomy granted as evaluated by faculty. However, on self-evaluations, female residents reported a lower degree of autonomy received.
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