Gender differences in surgical case volume among ophthalmology trainees

Abstract

Background The number of females in ophthalmology has steadily increased over recent decades. The aim of this study was to evaluate whether there is a difference in procedural volume and cataract surgery between male and female trainees in the Royal Australian and New Zealand College of Ophthalmologists (RANZCO). Methods A longitudinal retrospective review of de‐identified surgical RANZCO trainee logbook data from 2008 to 2020 was undertaken. Data from 241 trainee logbooks were analysed for: location of training, gender, date of commencement of training, maternity/paternity leave status, number of surgeries observed, assisted, supervised and unsupervised. Surgical cases were grouped as: (1) all surgical cases; (2) complete cataract cases and (3) partial cataract cases. Results Among 241 trainees (40.7% females), 197 263 procedures were performed. Total surgical volume was 21.1% lower at 4 years for females (median 665.5 vs. 843.5; p = 0.036). Completed cataract surgery was 21.5% lower at 18 months (median 87.5 vs. 111.5; p = 0.022) and 41.7% lower at 4 years (median 216 vs. 369; p < 0.001). Interrupted training was significantly more common in females (30.6% vs. 0.7%; p < 0.001). However, linear regression analysis did not identify parental leave or duration as a significant predictor for number of completed cataracts (p = 0.206). Complication rate was not different between males and females (p = 0.35). Conclusions Female trainees completed 41.7% fewer cataract operations at the end of their training compared to male counterparts with the gap widening between years 1 and 4 of training. The current data demonstrates that female and male RANZCO trainees are not receiving equivalent operating experiences.

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.…”

“…29 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.…”

Surgeons' perspectives on intraoperative gray area surgical complications of cataract surgery

“…Women continue to be underrepresented in ophthalmology and perform fewer cataract surgeries when compared with men at all stages of experience. [15][16][17] External pressures, such as hyperscrutiny from supervising physicians, who are mostly male, may exacerbate and independently contribute to female surgeons' predilection for disclosure and experienced anxiety. Moreover, women in ophthalmology encounter increased bias, harassment, and discrimination, while female trainees have reported fewer opportunities to perform surgeries and higher levels of bullying.…”

The impact of surgeon’s experience and sex on the incidence of cystoid macular edema after uneventful cataract surgery

“…The sex aspect in medical care is an issue of interest and has further gained importance in recent years. In recent studies by Gupta et al and Gill et al, intraoperative complications in cataract surgery between female and male surgeons in training did not differ significantly [ 37 , 38 ]. Hence, the number of women in surgical subspecialities in ophthalmology and the number of procedures completed by women shows disparities as reported by Gill et al [ 39 ] And this is only one gender inequality, besides women in leadership, academics and research, pay gap, harassment, career satisfaction and mentorship.…”