Colon and Rectal Surgery Robotic Training Programs: An Evaluation of Gender Disparities

Abstract

BACKGROUND: Female surgeons are subjected to implicit bias throughout their careers. The evaluation of gender bias in training is warranted with increasing numbers of female trainees in colon and rectal surgery. OBJECTIVE: This study aimed to evaluate gender bias in colon and rectal surgery training program operative experience. DESIGN: This is a retrospective cohort study. SETTING: The Association of Program Directors for Colon and Rectal Surgery robotic case log database contains operative details (procedure, attending surgeon, case percentage, and operative segments) completed by trainees as console surgeon for 2 academic years (2016–2017, 2017–2018). MAIN OUTCOME MEASURE: The primary outcomes measured are the percentage of trainee console participation and the completion of total mesorectal excision. Resident and attending surgeon gender was recorded retrospectively. The cohort was separated into 4 groups based on resident and attending surgeon gender combination. Case volume, average console participation per case, and completion of total mesorectal excisions were compared for each group by using interaction regression analysis. RESULTS: Fifty-two training programs participated, including 120 trainees and 190 attending surgeons. Forty-five (37.5%) trainees and 36 (18.9%) attending surgeons were women. The average number of cases per trainee was 23.27 per year for women and 28.15 per year for men (p = 0.19). Average console participation was 53.5% for women and 61.7% for men (p < 0.001). Male attending surgeons provided female trainees less console participation than male counterparts (52.1% vs 59.7%, p < 0.001). Female attending surgeons provided the same amount of console participation to female and male trainees (63.3% vs 61.8%, p = 0.62). Male trainees performed significantly more complete total mesorectal excision console cases than female trainees (57.16% vs 42.38%, p < 0.0001). LIMITATIONS: The data are subject to self-reporting bias. CONCLUSIONS: There is gender disparity in robotic operative experience in colon and rectal surgery training programs with less opportunity for console participation and less opportunity to complete total mesorectal excisions for female trainees. This trend should be highlighted and further evaluated to resolve this disparity. See Video Abstract at http://links.lww.com/DCR/B224. PROGRAMAS DE CAPACITACIÓN ROBÓTICA SOBRE CIRUGÍA DE COLON Y RECTO: UNA EVALUACIÓN DE LAS DISPARIDADES DE GÉNERO ANTECEDENTES: Cirujanos mujeres están sujetas a sesgos implícitos a lo largo de sus carreras. La evaluación del sesgo de género en el entrenamiento se amerita por un número cada vez mayor de aprendices femeniles en cirugía de colon y recto. OBJETIVO: Evaluar el sesgo de género en la experiencia operativa en programas de entrenamiento de cirugía de colon y recto. DISEÑO: Estudio de cohorte retrospectivo. ENTORNO CLINICO: La base de datos de registro de casos robóticos de la Asociación de Directores de Programas para Cirugía de Colon y Rectal contiene detalles operativos (procedimiento, cirujano asistente, porcentaje de casos y segmentos operativos) completados por los alumnos como cirujanos de consola durante dos años académicos (2016-17, 2017-18). MEDIDA DE VOLARACION PRINCIPAL: Porcentaje de participación de la consola de entrenamiento y finalización de la escisión mesorrectal total. Se registraron retrospectivamente el sexo de los médicos residentes y asistentes. La cohorte se separó en cuatro grupos según la combinación de género residente y asistente. El volumen de casos, la participación promedio de la consola por caso y la finalización de las extirpaciones mesorrectales totales se compararon para cada grupo mediante el análisis de regresión de interacción. RESULTADOS: Participaron 52 programas de capacitación, incluidos 120 aprendices y 190 cirujanos asistentes. Cuarenta y cinco (37.5%) aprendices y 36 (18.9%) cirujanos asistentes eran mujeres. El número promedio de casos por aprendiz fue de 23.27 / año para mujeres y 28.15 / año para hombres (p = 0.19). La participación promedio de la consola fue del 53.5% para las mujeres y del 61.7% para los hombres (p <0.001). Los cirujanos asistentes masculinos proporcionaron a las mujeres aprendices menos participación en la consola en comparación con sus compañeros masculinos (52.1% vs 59.7%, p <0.001). Los cirujanos asistentes femeninos proporcionaron la misma cantidad de participación en la consola a los aprendices femeninos y masculinos (63.3% vs 61.8%, p = 0.62). Los aprendices masculinos realizaron casos de consola TME significativamente más completos que las aprendices femeninas (57.16% vs 42.38%, p <0.0001). LIMITACIONES: Los datos están sujetos a sesgos de autoinforme. CONCLUSIONES: Existe una disparidad de género en la experiencia quirúrgica robótica en los programas de entrenamiento de cirugía de colon y recto con menos oportunidades para la participación de la consola y menos oportunidades para completar las extirpaciones mesorrectales totales para las mujeres en formación. Esta tendencia debe destacarse y evaluarse para resolver esta disparidad. Consulte Video Resumen en http://links.lww.com/DCR/B224. (Traducción—Dr. Adrián Ortega)

Early Barriers to Career Progression of Women in Surgery and Solutions to Improve Them

“…Women trainees were reported to be less likely to have children (2.5% female vs 40% male, P =0.0215 in the study by Rogers et al37; 19% female vs 49% male, P <0.001 in the study by Stephens et al39). When considering training opportunities, Foley et al40 reported significant differences in average console participation between sexes (53.5% female and 61.7% male, P <0.001); male attending surgeons were reported to provide female trainees with less console participation (52.1% vs 59.7%, P <0.001), while female attending surgeons provided the same amount of console participation to female and male trainees (63.3% vs 61.8%, P =0.62).…”

“…In total, 5 papers [37][38][39][40][41] reported significant differences between male and female trainees both in private and working environments. Women trainees were reported to be less likely to have children (2.5% female vs 40% male, P = 0.0215 in the study by Rogers et al 37 ; 19% female vs 49% male, P < 0.001 in the study by Stephens et al 39 ).…”

Comparison of short term surgical outcomes of male and female gastrointestinal surgeons in Japan: retrospective cohort study

“…Secondly, previous reports have shown a bias in the number of surgical cases assigned to male versus female surgeons during their training 30. Foley and colleagues reported gender differences in the experience with robotic surgery in colorectal surgery training programmes, with female trainees having fewer opportunities to participate in the use of consoles and to complete the procedures 31. They also reported that male supervisors provided fewer opportunities for console participation to female residents than to male residents, but female supervisors provided the same number of console use opportunities to both female and male trainees.…”

Surgical Experience Disparity Between Male and Female Surgeons in Japan

“…[25][26][27] Furthermore, female residents are significantly underrepresented among award recipients in general surgery residency programs. 28 In a study on gender disparity in robotic surgical experience in a colorectal surgery training program, 29 female residents had lower rates of console participation and fewer opportunities to complete total mesorectal excision than male residents. Furthermore, female attending surgeons offered equal opportunities for surgical experience to male and female residents, but male attending surgeons offered fewer opportunities to female residents.…”

“…Furthermore, female attending surgeons offered equal opportunities for surgical experience to male and female residents, but male attending surgeons offered fewer opportunities to female residents. 29 The majority of attending surgeons in Japan are male, and a prevailing gender bias among them may influence the surgical experience of residents.…”