Disparities in the Operative Experience Between Female and Male General Surgery Residents: A Multi-institutional Study From the US ROPE Consortium

Abstract

Objective: To examine differences in resident operative experience between male and female general surgery residents.

Background: Despite increasing female representation in surgery, sex and gender disparities in residency experience continue to exist. The operative volume of male and female general surgery residents has not been compared on a multi-institutional level.

Methods: Demographic characteristics and case logs were obtained for categorical general surgery graduates between 2010 and 2020 from the US Resident OPerative Experience Consortium database. Univariable, multivariable, and linear regression analyses were performed to compare differences in operative experience between male and female residents.

Results: There were 1343 graduates from 20 Accreditation Council for Graduate Medical Education-accredited programs, and 476 (35%) were females. There were no differences in age, race/ethnicity, or proportion pursuing fellowship between groups. Female graduates were less likely to be high-volume residents (27% vs 36%, P < 0.01). On univariable analysis, female graduates performed fewer total cases than male graduates (1140 vs 1177, P < 0.01), largely due to a diminished surgeon junior experience (829 vs 863, P < 0.01). On adjusted multivariable analysis, female sex was negatively associated with being a high-volume resident (OR = 0.74, 95% CI: 0.56 to 0.98, P = 0.03). Over the 11-year study period, the annual total number of cases increased significantly for both groups, but female graduates (+16 cases/year) outpaced male graduates (+13 cases/year, P = 0.02).

Conclusions: Female general surgery graduates performed significantly fewer cases than male graduates. Reassuringly, this gap in operative experience may be narrowing. Further interventions are warranted to promote equitable training opportunities that support and engage female residents.

FIGURE 1.

The operative experience of general surgery residents differs for female versus male general surgery residents. Male residents logged more total cases than female residents (1177 vs 1140, P < 0.01), largely due to differences in surgeon junior cases (863 vs 829, P < 0.01). *P < 0.05.

FIGURE 2.

The operative volume for male and female residents has increased over the past decade. On adjusted multivariable linear regression, (A) female graduates performed 13 fewer cases than male graduates in 2010 (P < 0.01), but the rate of increase for female graduates (+16 cases/yr) outpaced that of male graduates (+13 cases/yr, P = 0.02). (B) A similar relationship was found for surgeon junior cases, with female graduates performing 12 fewer cases than male graduates in 2010 (P < 0.01), but the differences in the rate of change did not reach statistical significance (P = 0.08). (C) There was no difference in the 2010 starting point or year-to-year trends for surgeon chief cases. (D) Female graduates performed 2 fewer TA cases than male residents (P = 0.02), but the differences in the rate of change were not different (P = 0.47).

FIGURE 3.

The difference in operative volume between female and male general surgery residents decreased with time. There was a significant difference in total cases between males and females (1135 vs 1077, P < 0.01) in the early period (years 2010 to 2015) but no difference (1218 vs 1193, P = 0.18) in the late period (years 2016–2020).