Does Your Gender Impact Resident Operative Experience? A Multi- Institutional Qualitative Study

Introduction: Recent quantitative data found that female surgical residents perform on average 37 fewer cases during their training than their male counterparts, which is equivalent to 1 to 3 months of operative experience. To further understand reasons for these observations, we performed focus groups among female general surgery residents.

Methods: Twenty- five participants from all PGY levels at 21 programs were recruited. Nine focus groups of 1 hour in length were held virtually and proctored by 3 facilitators. Each group had 1 to 4 female participants. Participants were asked questions on themes of disparities in operative experience, barriers, and avenues for improvement. Sessions were transcribed and coded for themes by 3 independent reviewers. Consensus with themes was reached between reviewers and a unified codebook was created.

Results: When asked how gender influenced their operative experience, residents commonly responded with themes of "microaggressions" such as hospitals not carrying their glove size, OR staff being reluctant to answer pages, feeling pressure to have more formal rather than informal communication with attending staff, and having to balance assertiveness/ confidence with being perceived negatively by others. When asked what barriers kept them out of the OR, female residents often responded that expectations (both internal and external) to complete all floor work prior to seeking operative experience was a significant barrier. They felt that this focus on administrative/floor task completion was disproportionately shouldered by females relative to their male peers. Other barriers included perceived lack of respect from attendings and OR staff leading to shying away from experiences, and feeling a reluctance to "claim space" in the operating room. Concerns surrounding pregnancy related discrimination, lack of support for fertility treatment, and poor lactation support/ resources were also expressed. Improvements suggested by female trainees included: increased faculty diversity, increased structured mentorship, standardization of case selection/ assignment, and setting of goals and expectations for autonomy.

Conclusions: We conclude that deleterious gender dominant cultural norms continue to exist in surgical residency training, and affect the operative experience of female residents. Equity education, setting clear expectations to attendings and house staff, and providing structured mentorship may represent solutions to remediate disparities in residency education.