Department of Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.
Department of Surgery, University of Washington, Seattle.
JAMA Surg. 2020 Jul 1;155(7):552-560. doi: 10.1001/jamasurg.2020.1127.
Factors contributing to underrepresentation of women in surgery are incompletely understood. Pro-male bias and stereotype threat appear to contribute to gender imbalance in surgery.
To evaluate the association between pro-male gender bias and career engagement and the effect of stereotype threat on skill performance among trainees in academic surgery.
DESIGN, SETTING, AND PARTICIPANTS: A 2-phase study with a double-blind, randomized clinical trial component was conducted in 3 academic general surgery training programs. Residents were recruited between August 1 and August 15, 2018, and the study was completed at the end of that academic year. In phase 1, surveys administered 5 to 6 months apart investigated the association of gender bias with career engagement. In phase 2, residents were randomized 1:1 using permuted-block design stratified by site, training level, and gender to receive either a trigger of or protection against stereotype threat. Immediately after the interventions, residents completed the Fundamentals of Laparoscopic Surgery (FLS) assessment followed by a final survey. A total of 131 general surgery residents were recruited; of these 96 individuals with academic career interests met eligibility criteria; 86 residents completed phase 1. Eighty-five residents were randomized in phase 2, and 4 residents in each arm were lost to follow-up.
Residents read abstracts that either reported that women had worse laparoscopic skill performance than men (trigger of stereotype threat [A]) or had no difference in performance (protection against stereotype threat [B]).
Association between perception of pro-male gender bias and career engagement survey scores (phase 1) and stereotype threat intervention and FLS scores (phase 2) were the outcomes. Intention-to-treat analysis was conducted.
Seventy-seven residents (38 women [49.4%]) completed both phases of the study. The association between pro-male gender bias and career engagement differed by gender (interaction coefficient, -1.19; 95% CI, -1.90 to -0.49; P = .02); higher perception of bias was associated with higher engagement among men (coefficient, 1.02; 95% CI, 0.19-2.24; P = .04), but no significant association was observed among women (coefficient, -0.25; 95% CI, -1.59 to 1.08; P = .50). There was no evidence of a difference in FLS score between interventions (mean [SD], A: 395 [150] vs B: 367 [157]; P = .51). The response to stereotype threat activation was similar in men and women (interaction coefficient, 15.1; 95% CI, -124.5 to 154.7; P = .39). The association between stereotype threat activation and FLS score differed by gender across levels of susceptibility to stereotype threat (interaction coefficient, -35.3; 95% CI, -47.0 to -23.6; P = .006). Higher susceptibility to stereotype threat was associated with lower FLS scores among women who received a stereotype threat trigger (coefficient, -43.4; 95% CI, -48.0 to -38.9; P = .001).
Perception of pro-male bias and gender stereotypes may influence career engagement and skill performance, respectively, among surgical trainees.
ClinicalTrials.gov Identifier: NCT03623009.
导致女性在外科领域代表性不足的因素尚未完全了解。男性偏好和刻板印象威胁似乎对外科领域的性别失衡产生了影响。
评估男性偏好性别偏见与职业投入之间的关联，以及刻板印象威胁对外科培训生技能表现的影响。
设计、地点和参与者：一项 2 阶段研究，包括一项双盲、随机临床试验部分，在 3 个学术普通外科培训项目中进行。居民于 2018 年 8 月 1 日至 8 月 15 日之间招募，并在该学年结束时完成研究。在第 1 阶段，相隔 5 至 6 个月进行的调查研究了性别偏见与职业投入之间的关联。在第 2 阶段，根据地点、培训水平和性别，以置换块设计进行 1:1 随机分组，以接受刻板印象威胁的触发或保护。干预措施后，居民立即完成腹腔镜基本技能评估（FLS），然后完成最终调查。共有 131 名普通外科住院医师被招募；其中 96 名具有学术职业兴趣的个体符合资格标准；86 名住院医师完成了第 1 阶段。85 名住院医师在第 2 阶段随机分组，每组有 4 名住院医师失访。
居民阅读了报告女性腹腔镜技能表现不如男性（刻板印象威胁触发 [A]）或表现无差异（刻板印象威胁保护 [B]）的摘要。
第 1 阶段（职业投入调查）和第 2 阶段（刻板印象威胁干预和 FLS 评分）的结果是感知男性偏好性别偏见与职业投入之间的关联和刻板印象威胁干预与 FLS 评分之间的关联。进行意向治疗分析。
77 名居民（38 名女性[49.4%]）完成了研究的两个阶段。男性与女性的男性偏好性别偏见与职业投入之间的关联存在差异（交互系数，-1.19；95%置信区间，-1.90 至-0.49；P=0.02）；更高的偏见感知与男性的更高投入相关（系数，1.02；95%置信区间，0.19-2.24；P=0.04），但在女性中未观察到显著关联（系数，-0.25；95%置信区间，-1.59 至 1.08；P=0.50）。干预措施之间 FLS 评分无差异（平均值[标准差]，A：395[150] vs B：367[157]；P=0.51）。男性和女性对刻板印象威胁激活的反应相似（交互系数，15.1；95%置信区间，-124.5 至 154.7；P=0.39）。刻板印象威胁激活与 FLS 评分之间的关联因性别和刻板印象威胁易感性的不同而不同（交互系数，-35.3；95%置信区间，-47.0 至-23.6；P=0.006）。更高的刻板印象威胁易感性与接受刻板印象威胁触发的女性 FLS 评分较低相关（系数，-43.4；95%置信区间，-48.0 至-38.9；P=0.001）。
外科培训生对男性偏好偏见和性别刻板印象的感知可能分别影响职业投入和技能表现。
ClinicalTrials.gov 标识符：NCT03623009。
