Differences in operative self-assessment between male and female plastic surgery residents: A survey of 8,149 cases

Cooney, Carisa M.; Aravind, Pathik; Lifchez, Scott D.; Hultman, C. Scott; Weber, Robert A.; Brooke, Sebastian; Cooney, Damon S.

doi:10.1016/j.amjsurg.2020.04.009

Cited by 27 publications

(29 citation statements)

References 14 publications

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“…[19][20][21][22][23] This reflects our experience documented in a study we published in 2020 in which we found women PGY-1 and PGY-3-PGY-6 residents significantly underrated and men PGY-2-PGY-6 residents significantly overrated their operative performance compared to attending assessments. 10 Given the finding by Sandhu et al that residents' self-perceived autonomy was significantly associated with attending-awarded OR entrustability, 24 men attendings may be more likely to award more entrustability to individuals displaying confident behaviors and requesting increases in autonomy rather than based on actual operative readiness. Similarly, resident self-assessments may be priming attendings' thoughts, contributing to unconscious anchoring of attendings' ratings.…”

Section: Level 5 Consultatory Guidancementioning

confidence: 98%

“…A previous study we performed showed that, as a group, women plastic surgery residents consistently underrated their OR skills compared both with their men colleagues and with attending physicians' assessments of their performance. 10 Therefore we performed the current study to determine if men and women plastic surgery residents are assessed differently by attending surgeons according to attending physician gender.…”

Section: Introductionmentioning

confidence: 99%

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An Analysis of Gender Bias in Plastic Surgery Resident Assessment

Cooney

Aravind

Hultman

et al. 2021

Journal of Graduate Medical Education

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Background Previous studies have shown men and women attending physicians rate or provide operating room (OR) autonomy differently to men and women residents, with men attendings providing higher ratings and more OR autonomy to men residents. Particularly with the advent of competency-based training in plastic surgery, differential advancement of trainees influenced by gender bias could have detrimental effects on resident advancement and time to graduation. Objective We determined if plastic surgery residents are assessed differently according to gender. Methods Three institutions' Operative Entrustability Assessment (OEA) data were abstracted from inception through November 2018 from MileMarker, a web-based program that stores trainee operative skill assessments of CPT-coded procedures. Ratings are based on a 5-point scale. Linear regression with postgraduate year adjustment was applied to all completed OEAs to compare men and women attendings' assessments of men and women residents. Results We included 8377 OEAs completed on 64 unique residents (25% women) by 51 unique attendings (29% women): men attendings completed 83% (n = 6972; 5859 assessments of men residents; 1113 of women residents) and women attendings completed 17% (n = 1405; 1025 assessments of men residents; 380 of women residents). Adjusted analysis showed men attendings rated women residents lower than men residents (P < .001); scores by women attendings demonstrated no significant difference (P = .067). Conclusions Our dataset including 4.5 years of data from 3 training programs showed men attendings scored women plastic surgery residents lower than their men counterparts.

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Section: Level 5 Consultatory Guidancementioning

confidence: 98%

Section: Introductionmentioning

confidence: 99%

An Analysis of Gender Bias in Plastic Surgery Resident Assessment

Cooney

Aravind

Hultman

et al. 2021

Journal of Graduate Medical Education

Self Cite

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“…16 Many other studies using a range of self-assessment instruments have also found that female residents are more self-critical than male residents. [16][17][18] One possible explanation for the difference in findings between this multicenter study of otolaryngology residents compared to studies that pooled data across surgery programs nationwide could be the nearly equal numbers of male and female trainees in the present study. In this study of large academic training programs where female trainees were no longer in the minority, female residents did not exhibit historically gender-based psychological phenomena like imposter syndrome.…”

Section: Discussionmentioning

confidence: 59%

Factors affecting operative autonomy and performance during otolaryngology training: A multicenter trial

Chen

Miller

Filimonov

et al. 2022

Laryngoscope Investig Oto

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Objective Surgical education is changing in an era of new regulations and evolving training cultures. We sought to understand the factors that affect operative experiences during otolaryngology residency. Methods From December 2019 to December 2020, five otolaryngology training programs used the SIMPL OR smartphone application to evaluate residents after each operation. Residents and attendings rated the trainee's autonomy on a 4‐level Zwisch scale, performance on a 5‐level scale, and case complexity on a 3‐level scale. We examined associations between ratings of autonomy and performance with variables including postgraduate year (PGY), case complexity, gender, week of the academic year (AY), and whether multiple procedures were logged. Results 78 attendings and 92 residents logged 2984 evaluations. PGY level and week of the AY were positively associated with attending ratings of autonomy and performance (PGY3 vs. PGY2: B = 0.63, p < .001 for autonomy and B = 1.05, p < .001 for performance; week of the AY: B = 0.013, p = .002 for autonomy; B = 0.025, p < .001 for performance). Multiple procedures logged and increasing case complexity were negatively associated with attending ratings (multiple procedures: B = −0.19, p = .04 for autonomy and B = −0.48, p < .001 for performance; hardest vs. easiest 1/3 of cases: B = −1.01, p < .001 for autonomy and B = −0.59, p < .001 for performance). Attending and trainee genders were not associated with attending ratings of autonomy or performance. Conclusion Resident autonomy and performance were positively associated with PGY level and week of the academic year, and negatively associated with case complexity and multiple procedures. These findings highlight the need to align training level with case complexity to promote quality operative experiences. Level of Evidence 2.

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“…Female students’ lower self-assessment with respect to scientifically based work could be due to their identity formation confirming to traditional roles [ 44 ] or due to teachers treating female students according to these roles [ 44 ]. In general, females often underestimate their performances, while men tend to overestimate them [ 15 , 45 ]. Medical schools need to be aware of such gender differences and could consider providing gender-specific mentoring programmes [ 46 ] to reduce these gender-specific differences.…”

Section: Discussionmentioning

confidence: 99%

Final-year medical students’ self-assessment of facets of competence for beginning residents

et al. 2022

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Background Final-year undergraduate medical students often do not feel well prepared for their start of residency training. Self-assessment of competences is important so that medical trainees can take responsibility for their learning. In this study, we investigated how final-year medical students self-assessed their competences as they neared their transition to postgraduate training. The aim was to identify areas for improvement in undergraduate training. Methods In the academic year 2019/2020, a national online survey was sent to final-year undergraduate medical students via their respective medical schools. The survey included ten facets of competence (FOC) most relevant for beginning residents. The participants were asked to self-assess their competence for each FOC on a 5-point Likert scale (1: strongly disagree to 5: strongly agree). We established an order of self-assessed FOC performance by means and calculated paired t-tests. Gender differences were assessed with independent t-tests. Results A total of 1083 students from 35 medical schools completed the questionnaire. Mean age was 27.2 ± 3.1 years and 65.8% were female. Students rated their performance highest in the FOCs ‘Teamwork and collegiality’ and ‘Empathy and openness’ (97.1 and 95.0% ‘strongly agree’ or ‘agree’, respectively) and lowest in ‘Verbal communication with colleagues and supervisors’ and ‘Scientifically and empirically grounded method of working’ (22.8 and 40.2% ‘strongly disagree’, ‘disagree’, or ‘neither agree nor disagree’, respectively). Women rated their performance of ‘Teamwork and collegiality’, ‘Empathy and openness’, and ‘Knowing and maintaining own personal bounds and possibilities’ significantly higher than men did (Cohen’s d > .2), while men showed higher self-assessed performance in ‘Scientifically and empirically grounded method of working’ than women (Cohen’s d = .38). The FOCs ‘Responsibility’, ‘Knowing and maintaining own personal bounds and possibilities’, ‘Structure, work planning, and priorities’, ‘Coping with mistakes’, and ‘Scientifically and empirically grounded method of working’ revealed lower self-assessed performance than the order of FOC relevance established by physicians for beginning residents. Conclusions The differences between the level of students’ self-assessed FOC performance and physicians’ ranking of FOC relevance revealed areas for improvement in undergraduate medical education related to health system sciences. Final-year students might benefit from additional or better training in management skills, professionalism, and evidence-based medicine. Surveys of self-assessed competences may be useful to monitor competence development during undergraduate training.

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Differences in operative self-assessment between male and female plastic surgery residents: A survey of 8,149 cases

Cited by 27 publications

References 14 publications

An Analysis of Gender Bias in Plastic Surgery Resident Assessment

An Analysis of Gender Bias in Plastic Surgery Resident Assessment

Factors affecting operative autonomy and performance during otolaryngology training: A multicenter trial

Final-year medical students’ self-assessment of facets of competence for beginning residents

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