415 Gender Differences in Operative Autonomy Using the Surgical Autonomy Program

Abstract

INTRODUCTION: While efforts to recruit females into surgical fields have increased, gender differences in surgical training exist. METHODS: The SAP divides a surgical case into four parts, or zones of proximal development (ZPD). For each ZPD, residents are evaluated on a 4-tier autonomy scale (TAGS scale). Using logistic regression analysis, we evaluated neurosurgery residents at Duke University Hospital from July 2017-July 2021 to compare differences in male and female trainee autonomy as rated by both attendings and residents. RESULTS: There were a total of 4,441 cases logged by 26 different residents and 30 attendings. 69% of residents were male (n = 18) and 31% (n = 8) were female. An ordinal regression analysis showed that female residents were given less autonomy than males by attendings (OR 0.59, 0.51-0.69 95% CI, p < 0.001). Females were also less likely to focus on a more complex ZPD (OR 0.53, 95% CI 0.46-0.61, p < 0.001). Based on self-evaluation, female residents rated their autonomy lower than males (OR 0.71, 0.61-0.82 95% CI, p < 0.001). Faculty provided greater intraoperative feedback in cases with female residents (84%, n = 539) compared to male residents (79%, n = 1,875) (X2 = 7.52, df = 1, p < 0.01). Female and male residents were fully autonomous on a similar proportion of cases in post-graduate year seven (73% and 72%, respectively). CONCLUSIONS: Female residents were given less autonomy compared to their male counterparts for index neurosurgical cases and were less likely to focus on a more complex portion of a case. Female residents were more self-critical, though received greater significant intraoperative feedback. Nonetheless, females and males were fully autonomous on a similar number of cases in their final residency year. Increased efforts are needed to address the gender gap within surgical education.