is Resident Physician, Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina, USA.
is Lead Statistician, Division of Global Neurosurgery, Duke University, Durham, North Carolina, USA.
J Grad Med Educ. 2024 Oct;16(5):517-524. doi: 10.4300/JGME-D-23-00682.1. Epub 2024 Oct 15.
The proportion of women surgeons is increasing, but studies show that women in surgical residency are granted less autonomy than men. 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. 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. From 128 residents (32 women, 25%), 11894 cases were included. Women were granted less autonomy (OR 0.81; 95% CI 0.74-0.89; <.001) and self-evaluated as having less autonomy (OR 0.73; 95% CI 0.67-0.80; <.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; <.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%; X=31.929; <.001). 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.
女性外科医生的比例正在增加，但研究表明，外科住院医师中的女性比男性获得的自主权更少。我们利用外科自主计划（SAP），这一教育框架，评估美国神经外科住院医师中自我报告的自主权、主治医生报告的自主权和手术反馈方面的性别差异。SAP 跟踪住院医师的进展并指导神经外科教学。手术被分为近端发展区（切开、显露、关键部分和关闭）。术后，由住院医师和主治医生对每个病例或区域的各个部分进行 4 分制的自主评分。我们利用了来自 2017 年 7 月至 2024 年 2 月 8 个机构的数据。使用有序回归评估性别、培训年限、病例难度和机构对自我和主治医生评估的自主权的影响。计算了不同时间点主治医生评估和自我评估之间的差异。使用卡方分析衡量对男性和女性的反馈有何差异。在 128 名住院医师（32 名女性，25%）中，共纳入 11894 例病例。女性获得的自主权较少（OR 0.81；95%CI 0.74-0.89；<.001），自我评估的自主权也较少（OR 0.73；95%CI 0.67-0.80；<.001）。与普通难度的手术相比，女性进行高自主手术的几率与进行困难病例的几率相似（OR 0.77；95%CI 0.71-0.84；<.001）。随着时间的推移，男性和女性的自我评估与主治医生的评估越来越接近，女性在手术的关键部分提高得更快。女性住院医师收到的术后反馈较少（女性：74.2%，男性：80.5%；X=31.929；<.001）。主治医生和住院医师都认为女性的自主权较低，但性别差距随着时间的推移而缩小。女性也从主治医生那里得到的反馈较少。
