Resident Operative Autonomy in Robotic Surgery Training: Unpacking Gender Disparities and Training Trends

J Surg Educ. 2024 Dec;81(12):103312. doi: 10.1016/j.jsurg.2024.103312. Epub 2024 Oct 24.

Abstract

Objective: This study evaluated resident and program-level factors associated with resident-reported robotic operative autonomy at our institution.

Design: This retrospective cohort study evaluates self-reported residents' robotic case logs detailing case type, console time, and portions of the case completed. The analysis included three procedures: pancreaticoduodenectomies, hernia repairs, and low anterior resection. Each procedure was divided into four key portions. Outcomes measured included minutes at the console and High Resident Autonomy (HRA), defined as >50% resident case participation. Independent variables included graduation cohort, pursued fellowship type, attending gender, underrepresented minority status, and hospital type. Univariable and multivariable logistic regression were performed.

Setting: This study took place at the University of Texas Southwestern Medical Center General Surgery Residency between 2021 and 2023.

Participants: Twenty-nine chief residents (postgraduate year 5).

Results: Of the 541 cases, 61% were hernia repairs, 26% were low anterior resections, and 13% were pancreaticoduodenectomies. Female residents were present in 60% of the cases. Male residents reported more HRA (76% vs. 54%) and longer console times (150 vs 120 minutes; p < 0.01). Multivariable analysis indicated female gender was associated with 74% lower odds of HRA (95% CI: 0.15 - 0.45; p < 0.001) and 18 fewer minutes of console time versus males (p < 0.01). The 2023 cohort had significantly higher odds of HRA than the 2021 cohort (OR: 4.46, 95% CI: 2.34 - 8.51; p < 0.001) and 15 more console minutes. Residents with aligned fellowships spent 37 more console minutes than those without (p < 0.001). No significant differences were found between attending gender, hospital, and minority status.

Conclusions: Our findings reveal significant gender disparities in self-reported operative autonomy and console time. The recent cohort showed improved training outcomes, and fellowship alignment with the case positively impacted console time. This suggests a need to refine training approaches, ensuring equity and optimizing training efficacy.

Keywords: Resident autonomy; disparities; robotic surgery; surgical education.

MeSH terms

  • Adult
  • Clinical Competence
  • Education, Medical, Graduate / methods
  • Female
  • General Surgery* / education
  • Humans
  • Internship and Residency*
  • Male
  • Professional Autonomy*
  • Retrospective Studies
  • Robotic Surgical Procedures* / education
  • Texas