Gender Differences in Operative Autonomy Using the Surgical Autonomy Program: A Multicenter Study. J Grad Med Educ 2024 Oct;16(5):517-524
Date
10/17/2024Pubmed ID
39416402Pubmed Central ID
PMC11475442DOI
10.4300/JGME-D-23-00682.1Scopus ID
2-s2.0-85206657590 (requires institutional sign-in at Scopus site) 2 CitationsAbstract
Background The proportion of women surgeons is increasing, but studies show that women in surgical residency are granted less autonomy than men. Objective We utilized the Surgical Autonomy Program (SAP), an educational framework, to evaluate gender differences in self-reported autonomy, attending-reported autonomy, and operative feedback among US neurosurgical residents. Methods The SAP tracks resident progression and guides teaching in neurosurgery. Surgeries are divided into zones of proximal development (opening, exposure, critical portion, and closure). Postoperatively, resident autonomy is rated on a 4-point scale by the resident and the attending for each part of the case, or zone. We utilized data from July 2017 to February 2024 from 8 institutions. Ordinal regression was used to evaluate the odds of self- and attending-evaluated autonomy, accounting for gender, training year, case difficulty, and institution. Differences between attending assessment and self-assessment were calculated across time. Chi-square analyses were used to measure any differences in feedback given to men and women. Results From 128 residents (32 women, 25%), 11894 cases were included. Women were granted less autonomy (OR 0.81; 95% CI 0.74-0.89; P<.001) and self-evaluated as having less autonomy (OR 0.73; 95% CI 0.67-0.80; P<.001). The odds of women operating at higher autonomy were similar to the odds of operating on a hard case compared to average difficulty (OR 0.77; 95% CI 0.71-0.84; P<.001). Men's and women's self-assessment became closer to attending assessment over time, with women improving more quickly for the critical portions of surgeries. Women residents received meaningful postoperative feedback on fewer cases (women: 74.2%, men: 80.5%; X2=31.929; P<.001). Conclusions Women operated with lower autonomy by both attending and self-assessment, but the assessment gap between genders decreased over time. Women also received less feedback from their attendings.
Author List
Kirsch EP, Venkatraman V, Deng D, McDaniel KE, Suarez AD, Lew SM, Orina J, Silberstein H, Goldstein I, Gould G, Gandhi CD, Patil C, Dengler BA, Dharmapurikar R, Lad SP, Haglund MMAuthor
Sean Lew MD Chief, Professor in the Neurosurgery department at Medical College of WisconsinMESH terms used to index this publication - Major topics in bold
Clinical CompetenceEducation, Medical, Graduate
Female
Humans
Internship and Residency
Male
Neurosurgical Procedures
Physicians, Women
Professional Autonomy
Self-Assessment
Sex Factors
United States
