Zmijewski Polina, Aleman Carla, Panzica Nicole, Akhund Ramsha, Lindeman Brenessa, Chen Herbert, Lynch Kenneth, Cortez Alexander R, Fazendin Jessica
Department of Surgery, The University of Alabama at Birmingham, Birmingham, AL, USA.
Department of Surgery, The University of Alabama at Birmingham, Birmingham, AL, USA.
J Surg Educ. 2025 Feb;82(2):103368. doi: 10.1016/j.jsurg.2024.103368. Epub 2024 Dec 21.
Recent quantitative data found that female surgical residents perform on average 37 fewer cases during their training than their male counterparts, which is equivalent to 1 to 3 months of operative experience. To further understand reasons for these observations, we performed focus groups among female general surgery residents.
Twenty- five participants from all PGY levels at 21 programs were recruited. Nine focus groups of 1 hour in length were held virtually and proctored by 3 facilitators. Each group had 1 to 4 female participants. Participants were asked questions on themes of disparities in operative experience, barriers, and avenues for improvement. Sessions were transcribed and coded for themes by 3 independent reviewers. Consensus with themes was reached between reviewers and a unified codebook was created.
When asked how gender influenced their operative experience, residents commonly responded with themes of "microaggressions" such as hospitals not carrying their glove size, OR staff being reluctant to answer pages, feeling pressure to have more formal rather than informal communication with attending staff, and having to balance assertiveness/ confidence with being perceived negatively by others. When asked what barriers kept them out of the OR, female residents often responded that expectations (both internal and external) to complete all floor work prior to seeking operative experience was a significant barrier. They felt that this focus on administrative/floor task completion was disproportionately shouldered by females relative to their male peers. Other barriers included perceived lack of respect from attendings and OR staff leading to shying away from experiences, and feeling a reluctance to "claim space" in the operating room. Concerns surrounding pregnancy related discrimination, lack of support for fertility treatment, and poor lactation support/ resources were also expressed. Improvements suggested by female trainees included: increased faculty diversity, increased structured mentorship, standardization of case selection/ assignment, and setting of goals and expectations for autonomy.
We conclude that deleterious gender dominant cultural norms continue to exist in surgical residency training, and affect the operative experience of female residents. Equity education, setting clear expectations to attendings and house staff, and providing structured mentorship may represent solutions to remediate disparities in residency education.
最近的定量数据发现，女性外科住院医师在培训期间平均比男性同行少做37例手术，这相当于1至3个月的手术经验。为了进一步了解这些观察结果的原因，我们对女性普通外科住院医师进行了焦点小组访谈。
招募了来自21个项目所有住院医师培训阶段的25名参与者。通过3名主持人以线上方式进行了9个时长为1小时的焦点小组访谈。每个小组有1至4名女性参与者。就手术经验差异、障碍及改进途径等主题向参与者提问。访谈内容由3名独立评审员转录并编码主题。评审员之间就主题达成共识并创建了统一的编码手册。
当被问及性别如何影响她们的手术经验时，住院医师们普遍回应了“微侵犯”等主题，比如医院没有她们合适的手套尺寸、手术室工作人员不愿接听呼叫、感到与主治医生进行更正式而非非正式交流的压力，以及必须在坚定自信与被他人负面看待之间取得平衡。当被问及是什么障碍使她们无法进入手术室时，女性住院医师常回答说，在寻求手术经验之前完成所有病房工作的期望（包括内部和外部期望）是一个重大障碍。她们觉得相对于男性同行，女性承担了过多关注行政/病房任务完成的负担。其他障碍包括感觉得不到主治医生和手术室工作人员的尊重从而回避相关经历，以及在手术室中不愿“争取空间”。还表达了对与怀孕相关的歧视、缺乏生育治疗支持以及泌乳支持/资源不足的担忧。女性受训者提出的改进建议包括：增加教员多样性、增加结构化指导、病例选择/分配的标准化，以及设定自主权的目标和期望。
我们得出结论，有害的性别主导文化规范在外科住院医师培训中仍然存在，并影响女性住院医师的手术经验。公平教育、向主治医生和住院医生明确期望，以及提供结构化指导可能是解决住院医师培训中差异问题的办法。
