Division of Vascular and Endovascular Surgery, University of Virginia School of Medicine, Charlottesville, VA.
Division of Vascular Surgery, University of Utah School of Medicine, Salt Lake City, UT.
J Vasc Surg. 2024 Jul;80(1):260-267.e2. doi: 10.1016/j.jvs.2024.03.019. Epub 2024 Mar 15.
Gender disparities in surgical training and assessment are described in the general surgery literature. Assessment disparities have not been explored in vascular surgery. We sought to investigate gender disparities in operative assessment in a national cohort of vascular surgery integrated residents (VIRs) and fellows (VSFs).
Operative performance and autonomy ratings from the Society for Improving Medical Professional Learning (SIMPL) application database were collected for all vascular surgery participating institutions from 2018 to 2023. Logistic generalized linear mixed models were conducted to examine the association of faculty and trainee gender on faculty and self-assessment of autonomy and performance. Data were adjusted for post-graduate year and case complexity. Random effects were included to account for clustering effects due to participant, program, and procedure.
One hundred three trainees (n = 63 VIRs; n = 40 VSFs; 63.1% men) and 99 faculty (73.7% men) from 17 institutions (n = 12 VIR and n = 13 VSF programs) contributed 4951 total assessments (44.4% by faculty, 55.6% by trainees) across 235 unique procedures. Faculty and trainee gender were not associated with faculty ratings of performance (faculty gender: odds ratio [OR], 0.78; 95% confidence interval [CI], 0.27-2.29; trainee gender: OR, 1.80; 95% CI, 0.76-0.43) or autonomy (faculty gender: OR, 0.99; 95% CI, 0.41-2.39; trainee gender: OR, 1.23; 95% CI, 0.62-2.45) of trainees. All trainees self-assessed at lower performance and autonomy ratings as compared with faculty assessments. However, women trainees rated themselves significantly lower than men for both autonomy (OR, 0.57; 95% CI, 0.43-0.74) and performance (OR, 0.40; 95% CI, 0.30-0.54).
Although gender was not associated with differences in faculty assessment of performance or autonomy among vascular surgery trainees, women trainees perceive themselves as performing with lower competency and less autonomy than their male colleagues. These findings suggest utility for exploring gender differences in real-time feedback delivered to and received by trainees and targeted interventions to align trainee self-perception with actual operative performance and autonomy to optimize surgical skill acquisition.
外科培训和评估中的性别差异在普通外科学文献中有描述。血管外科学中尚未探讨评估方面的差异。我们试图在全国血管外科综合住院医师（VIR）和研究员（VSF）队列中调查手术评估中的性别差异。
从 2018 年至 2023 年，从参与的血管外科机构的 Society for Improving Medical Professional Learning（SIMPL）应用程序数据库中收集手术表现和自主权评估数据。使用逻辑广义线性混合模型，考察教员和学员的性别对教员和自我评估的自主性和表现的关联。数据根据毕业后的年限和病例复杂性进行调整。随机效应用于解释由于参与者、项目和程序而导致的聚类效应。
来自 17 个机构的 103 名学员（n=63 名 VIR；n=40 名 VSF；63.1%为男性）和 99 名教员（73.7%为男性）在 12 个 VIR 和 13 个 VSF 项目中参与了 235 项不同手术，共提供了 4951 项评估（44.4%由教员评估，55.6%由学员评估）。教员和学员的性别与教员对表现的评估（教员性别：比值比[OR]，0.78；95%置信区间[CI]，0.27-2.29；学员性别：OR，1.80；95%CI，0.76-0.43）或学员的自主权（教员性别：OR，0.99；95%CI，0.41-2.39；学员性别：OR，1.23；95%CI，0.62-2.45）无关。与教员评估相比，所有学员的自我评估在表现和自主权方面都较低。然而，与男性学员相比，女性学员对自主性（OR，0.57；95%CI，0.43-0.74）和表现（OR，0.40；95%CI，0.30-0.54）的自我评估明显较低。
尽管性别与血管外科学员中教员对表现或自主权评估的差异无关，但女性学员认为自己的表现能力和自主权低于男性同事。这些发现表明，在向学员提供和接受实时反馈方面，以及在针对学员自我认知与实际手术表现和自主权的针对性干预方面，探索性别差异具有实用性，以优化手术技能的获取。
