Jenny X Chen1, Edward H Chang2, Francis Deng3, Shari Meyerson4, Brian George5, Elliott D Kozin6, Stacey T Gray7. 1. is a Clinical Fellow, Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Harvard Medical School. 2. is Assistant Professor of Business Administration, Negotiation, Organizations and Markets Unit, Harvard Business School. 3. is a Clinical Fellow, Department of Radiology, Massachusetts General Hospital, Harvard Medical School. 4. is Professor of Medicine, Department of Thoracic Surgery, University of Kentucky. 5. is Assistant Professor of Surgery, Department of Surgery, Center for Surgical Training and Research, Michigan Medicine. 6. is Assistant Professor, Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Harvard Medical School. 7. is Associate Professor, Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Harvard Medical School.
Abstract
BACKGROUND: Gender disparities are prevalent in medicine, but their impact on surgical training is not well studied. OBJECTIVE: To quantify gender disparities in trainee intraoperative experiences and explore the variables associated with ratings of surgical autonomy and performance. METHODS: From September 2015 to May 2019, attending surgeons and trainees from 71 programs assessed trainee autonomy on a 4-level Zwisch scale and performance on a 5-level modified Dreyfus scale after surgical procedures. Multivariable regression models were used to examine the association of trainee gender with autonomy and performance evaluations. RESULTS: A total of 3255 trainees and attending surgeons completed 94 619 evaluations. Attendings gave lower ratings of operative autonomy to female trainees than male trainees when controlling for training level, attending, and surgical procedure (effect size B = -0.0199, P = .008). There was no difference in ratings of autonomy at the beginning of training (P = .32); the gap emerged as trainees advanced in years (B = -0.0163, P = .020). The gender difference in autonomy was largest for the most complex cases (B = -0.0502, P = .002). However, there was no difference in attending ratings of surgical performance for female trainees compared to male trainees (B = -0.0124, P = .066). Female trainees rated themselves as having less autonomy and worse performance than males when controlling for training level, attending, procedure, case complexity, and attending ratings (autonomy B = -0.0669, P < .001; performance B = -0.0704, P < .001). CONCLUSIONS: While there was no significant difference in ratings of operative performance, a small difference between ratings of operative autonomy for female and male surgical trainees was identified.
BACKGROUND: Gender disparities are prevalent in medicine, but their impact on surgical training is not well studied. OBJECTIVE: To quantify gender disparities in trainee intraoperative experiences and explore the variables associated with ratings of surgical autonomy and performance. METHODS: From September 2015 to May 2019, attending surgeons and trainees from 71 programs assessed trainee autonomy on a 4-level Zwisch scale and performance on a 5-level modified Dreyfus scale after surgical procedures. Multivariable regression models were used to examine the association of trainee gender with autonomy and performance evaluations. RESULTS: A total of 3255 trainees and attending surgeons completed 94 619 evaluations. Attendings gave lower ratings of operative autonomy to female trainees than male trainees when controlling for training level, attending, and surgical procedure (effect size B = -0.0199, P = .008). There was no difference in ratings of autonomy at the beginning of training (P = .32); the gap emerged as trainees advanced in years (B = -0.0163, P = .020). The gender difference in autonomy was largest for the most complex cases (B = -0.0502, P = .002). However, there was no difference in attending ratings of surgical performance for female trainees compared to male trainees (B = -0.0124, P = .066). Female trainees rated themselves as having less autonomy and worse performance than males when controlling for training level, attending, procedure, case complexity, and attending ratings (autonomy B = -0.0669, P < .001; performance B = -0.0704, P < .001). CONCLUSIONS: While there was no significant difference in ratings of operative performance, a small difference between ratings of operative autonomy for female and male surgical trainees was identified.
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Authors: Jenny X Chen; Lauren E Miller; Andrey Filimonov; Elizabeth A Shuman; Emily Marchiano; Brian C George; Marc Thorne; Steven D Pletcher; Michael Platt; Marita Teng; Elliott D Kozin; Stacey T Gray Journal: Laryngoscope Investig Otolaryngol Date: 2022-02-01