Harvard Medical School, Boston, Massachusetts; Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
J Surg Res. 2022 Nov;279:104-112. doi: 10.1016/j.jss.2022.05.020. Epub 2022 Jun 24.
Gender disparities in resident operative experience have been described; however, their etiology is poorly understood, and racial/ethnic disparities have not been explored. This study investigated the relationship between gender, race/ethnicity, and surgery resident case volumes.
A retrospective analysis of graduating general surgery resident case logs (2010-2020) at an academic medical center was performed. Self-reported gender and race/ethnicity data were collected from program records. Residents were categorized as underrepresented in medicine (URM) (Black, Hispanic, Native American) or non-URM (White, Asian). Associations between gender and URM status and major, chief, and teaching assistant (TA) mean case volumes were analyzed using t-tests.
The cohort included 80 residents: 39 female (48.8%) and 17 URM (21.3%). Compared to male residents, female residents performed fewer TA cases (33 versus 47, P < 0.001). Compared to non-URM residents, URM residents graduated with fewer major (948 versus 1043, P = 0.008) and TA cases (32 versus 42, P = 0.038). Male URM residents performed fewer TA cases than male non-URM residents (32 versus 50, P = 0.031). Subanalysis stratified by graduation year demonstrated that from 2010 to 2015, female residents performed fewer chief (218 versus 248, P = 0.039) and TA cases (29 versus 50, P = 0.001) than male residents. However, from 2016 to 2020, when gender parity was achieved, no significant associations were observed between gender and case volumes.
Female and URM residents perform fewer TA and major cases than male non-URM residents, which may contribute to reduced operative autonomy, confidence, and entrustment. Prioritizing gender and URM parity may help decrease case volume gaps among underrepresented residents.
已经描述了住院医师手术经验中的性别差异；然而，其病因尚不清楚，种族/民族差异也尚未得到探讨。本研究调查了性别、种族/民族与外科住院医师手术量之间的关系。
对一家学术医疗中心的普外科住院医师手术日志（2010-2020 年）进行了回顾性分析。从项目记录中收集了自我报告的性别和种族/民族数据。住院医师分为医学上代表性不足的群体（URM）（黑人、西班牙裔、美国原住民）或非 URM（白人、亚洲人）。使用 t 检验分析了性别和 URM 状态与主要手术、首席手术和助教（TA）平均手术量之间的关系。
该队列包括 80 名住院医师：39 名女性（48.8%）和 17 名 URM（21.3%）。与男性住院医师相比，女性住院医师的 TA 手术量较少（33 例比 47 例，P<0.001）。与非 URM 住院医师相比，URM 住院医师的主要手术量和 TA 手术量更少（948 例比 1043 例，P=0.008；32 例比 42 例，P=0.038）。男性 URM 住院医师的 TA 手术量少于男性非 URM 住院医师（32 例比 50 例，P=0.031）。按毕业年份进行的亚组分析表明，2010 年至 2015 年期间，女性住院医师的首席手术量和 TA 手术量均少于男性住院医师（218 例比 248 例，P=0.039；29 例比 50 例，P=0.001）。然而，2016 年至 2020 年期间，当实现性别均等后，性别与手术量之间没有显著关联。
女性和 URM 住院医师的 TA 和主要手术量少于男性非 URM 住院医师，这可能导致手术自主性、信心和委托减少。优先考虑性别和 URM 均等可能有助于减少代表性不足的住院医师的手术量差距。
