Resident autonomy in the operating room: Does gender matter?

Introduction: Previous data examining the effect of gender on surgical trainee autonomy is lacking. We hypothesized that female general surgery residents have less autonomy than males during laparoscopic cases. Methods: We retrospectively reviewed factors associated with level of guidance needed during laparoscopic procedures as reported on intraoperative procedure feedback forms and on FLS tasks from one institution from 2013 to 2016. Data collected included resident and attending gender, level of guidance needed, PGY level, case characteristics, resident intraoperative performance, and skills lab FLS performance. Univariate and multivariate analyses were performed using a mixed-effects regression model. Results: We analyzed data from 106 PGY1-PGY5 residents (51% Female) and 104 attendings (26% Female). Female resident gender was associated with more intraoperative guidance in univariate (p = 0.019) and multivariate analysis (p = 0.034). Technical performance between genders was similar. Conclusions: This study demonstrated gender-based inequality in intraoperative autonomy even after controlling for technical performance, PGY level, and case factors.