Xu Sherri, McAlpine Heidi, Drummond Katharine Jann
Department of Surgery, The University of Melbourne, Parkville, Australia.
Department of Surgery, The University of Melbourne, Parkville, Australia; Department of Neurosurgery, The Royal Melbourne Hospital, Parkville, VIC, Australia.
J Surg Res. 2025 Feb;306:327-335. doi: 10.1016/j.jss.2024.12.004. Epub 2025 Jan 21.
Assessing gender disparity in surgical trainees' operative opportunities and experience quantifies implicit gender bias and reflects a summation of many smaller biased interactions within the operating room environment. Highlighting gender disparity in surgery informs a platform for advocacy.
A systematic literature search was performed using Medline, Web of Science, OpenMD and Science Direct consistent with the Preferred Reporting Items for Systematic Reviews and Metanalysis guidelines. A Boolean search strategy was used to identify articles relevant to gender in operative surgery. Only English language studies that assessed the gender of surgical trainees with regards to operative cases for total and/or autonomously performed case numbers were included.
Fifteen papers assessing the influence of gender on operative opportunities for trainee surgeons were identified. A discrepancy between the operative experiences of men and women trainee surgeons was found. Of eight studies assessing gender differences in total case numbers, four reported women undertaking fewer total cases than men; a similar trend was demonstrated in two studies that failed to reach statistical significance. Eight of eleven studies examining surgical autonomy reported more surgical autonomy afforded to men trainee surgeons than women.
A gendered bias in the operative opportunities afforded to trainee surgeons is suggested in the literature, reflecting implicit bias that underlies surgical culture worldwide. Although surgical specialties continue to have vast gender inequity, we fail to leverage talent and the benefits of diverse skills and experience, to the detriment of ourselves and our patients. Quantifying this issue will inform change.
评估外科住院医师手术机会和经验中的性别差异，可量化隐性性别偏见，并反映手术室环境中许多较小的偏见性互动的总和。突出手术领域的性别差异为倡导提供了一个平台。
按照系统评价和Meta分析的首选报告项目指南，使用Medline、Web of Science、OpenMD和ScienceDirect进行系统的文献检索。采用布尔检索策略来识别与手术中的性别相关的文章。仅纳入评估外科住院医师在总手术病例数和/或自主完成病例数方面性别的英文研究。
共识别出15篇评估性别对实习外科医生手术机会影响的论文。发现男女实习外科医生的手术经验存在差异。在八项评估总病例数性别差异的研究中，四项报告称女性的总病例数少于男性；两项未达到统计学显著性的研究也显示出类似趋势。在十一项研究手术自主性的研究中，八项报告称男性实习外科医生比女性获得更多的手术自主性。
文献表明，实习外科医生的手术机会存在性别偏见，反映了全球外科文化中潜在的隐性偏见。尽管外科专业仍然存在巨大的性别不平等，但我们未能充分利用人才以及多样化技能和经验带来的好处，这对我们自己和患者都不利。量化这个问题将推动变革。
