Gender Differences in Operative Autonomy Using the Surgical Autonomy Program: A Multicenter Study.

Area of Science:

• Neurosurgery Training
• Medical Education
• Surgical Residency

Background:

• Increasing proportion of women in surgery.
• Existing evidence suggests gender disparities in surgical resident autonomy.
• Need to investigate these differences in neurosurgery.

Purpose of the Study:

• Evaluate gender differences in autonomy using the Surgical Autonomy Program (SAP).
• Compare self-reported and attending-reported autonomy in neurosurgical residents.
• Analyze operative feedback differences between male and female residents.

Main Methods:

• Utilized data from the Surgical Autonomy Program (SAP) across 8 institutions (July 2017-February 2024).
• Assessed resident autonomy in defined surgical zones (opening, exposure, critical portion, closure).
• Employed ordinal regression and chi-square analyses to compare autonomy and feedback by gender, controlling for covariates.

Main Results:

• Women residents were granted significantly less autonomy (OR 0.81) and self-evaluated lower autonomy (OR 0.73) than men.
• The odds of women operating at higher autonomy were comparable to operating on a hard case.
• The autonomy assessment gap between genders decreased over time, with women improving faster in critical portions; women received less feedback (74.2% vs 80.5%).

Conclusions:

• Women neurosurgical residents experience lower autonomy, both self-assessed and attending-assessed.
• The gender gap in autonomy assessment narrowed during training.
• Women residents received less postoperative feedback, indicating a persistent disparity in surgical education.