Ratio of Economy of Motion to Assess Gender Differences in Trainee Autonomy During Robotic Surgery-A Feasibility...

Gender of trainees and attending surgeons has been shown to influence levels of trainee autonomy (TA) during surgical training. In this study, we evaluated the feasibility of an objective performance indicator, the ratio of economy of motion (rEOM), to assess differences in TA by gender during dual-console colorectal procedures.

In this retrospective feasibility study, endoscopic videos from 87 procedures were annotated to identify distinct surgical step visits. Utilizing rEOM, each step visit was attributed to either the attending surgeon or the trainee. TA was compared across six female and four male general surgery chief residents, along with one female and three male colorectal surgery fellows.

During 87 procedures, of which 73 were robotic proctectomies and 14 were robotic right colectomies, a total of 2662 step visits were analyzed. Male fellows performed more step visits during all cases (36.8% versus 21.7%; P = 0.019) and right colectomies (34.0% versus 14.6%; P = 0.021). In cases with male attendings, male fellows completed more step visits per procedure (36.8% versus 21.7%; P = 0.034). During right colectomies with male attendings, all male trainees performed a greater percentage of step visits per procedure (35.7% versus 15.0%; P = 0.020). No significant differences were seen in TA between all male and female trainees in surgeries with female attendings.

This study demonstrates the feasibility of using rEOM to assess gender differences in TA and/or trainer entrustment. We used rEOM to delineate surgical step ownership, and although our sample size only allows hypotheses-generating inferences, we identified differences in TA between male and female trainees during robotic procedures.