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. 2023 Jul 1;105-B(7):821-832.
doi: 10.1302/0301-620X.105B7.BJJ-2023-0132.R2.

The role of Gender in Operative Autonomy in orthopaedic Surgical Trainees (GOAST)

Samantha Downie  1 , Jennifer Cherry  2 , Jennifer Dunn  1 , Thomas Harding  1 , Deborah Eastwood  3 , Sarah Gill  4 , Simon Johnson  1 ; BORCo collaborative authors
Collaborators, Affiliations

The role of Gender in Operative Autonomy in orthopaedic Surgical Trainees (GOAST)

Samantha Downie et al. Bone Joint J. .

Abstract

Aims: Global literature suggests that female surgical trainees have lower rates of independent operating (operative autonomy) than their male counterparts. The objective of this study was to identify any association between gender and lead/independent operating in speciality orthopaedic trainees within the UK national training programme.

Methods: This was a retrospective case-control study using electronic surgical logbook data from 2009 to 2021 for 274 UK orthopaedic trainees. Total operative numbers and level of supervision were compared between male and female trainees, with correction for less than full-time training (LTFT), prior experience, and time out during training (OOP). The primary outcome was the percentage of cases undertaken as lead surgeon (supervised and unsupervised) by UK orthopaedic trainees by gender.

Results: All participants gave permission for their data to be used. In total, 274 UK orthopaedic trainees submitted data (65% men (n = 177) and 33% women (n = 91)), with a total of 285,915 surgical procedures logged over 1,364 trainee-years. Males were lead surgeon (under supervision) on 3% more cases than females (61% (115,948/189,378) to 58% (50,285/86,375), respectively; p < 0.001), and independent operator (unsupervised) on 1% more cases. A similar trend of higher operative numbers in male trainees was seen for senior (ST6 to 8) trainees (+5% and +1%; p < 0.001), those with no time OOP (+6% and +8%; p < 0.001), and those with orthopaedic experience prior to orthopaedic specialty training (+7% and +3% for lead surgeon and independent operator, respectively; p < 0.001). The gender difference was less marked for those on LTFT training, those who took time OOP, and those with no prior orthopaedic experience.

Conclusion: This study showed that males perform 3% more cases as the lead surgeon than females during UK orthopaedic training (p < 0.001). This may be due to differences in how cases are recorded, but must engender further research to ensure that all surgeons are treated equitably during their training.

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Conflict of interest statement

The authors declare no potential conflicts of interest. D. Eastwood reports book royalties from Oxford University Press,and participation on the SCIENCE Study Data Monitoring Board, unrelated to this study. D. Eastwood is also President of the British Orthopaedic Association, and an editorial board member of The Bone & Joint Journal. S. Gill reports payment from DePuy Synthes for teaching a June 2022 course, and sponsorship for attendance of a December 2022 masterclass, neither of which are related to this study.

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