Gender Differences in Trainee Case Load in Surgical Training: A Systematic Review and Meta-Analysis

Area of Science:

• Medical Education
• Surgical Training
• Gender Equity

Background:

• Gender equity in surgical training is crucial for patient care and workforce representation.
• Despite increased female enrollment, disparities in case load, procedural complexity, and autonomy persist.
• This review assesses gender disparities in surgical training and their impact on outcomes.

Purpose of the Study:

• To systematically review and quantify gender disparities in surgical trainee operative case loads.
• To evaluate the impact of these disparities on training outcomes and workforce equity.
• To identify potential interventions for addressing gender inequities in surgical education.

Main Methods:

• Systematic review following PRISMA guidelines, searching PubMed, MEDLINE, and EMBASE databases up to May 2024.
• Inclusion of studies reporting gender-delineated surgical trainee case loads or autonomy (≥20 participants).
• Random-effects meta-analysis to calculate pooled male-to-female case ratios, accounting for heterogeneity.

Main Results:

• 18 studies (4139 trainees) met criteria; meta-analysis showed males performed ~17% more cases overall (M:F ratio 1.17, p<0.0001).
• Male trainees had ~63% higher volumes in basic procedures (p=0.0004) and ~61% in complex procedures (p=0.0065).
• Consistent underrepresentation of female trainees in both basic and complex operative experience was observed across studies.

Conclusions:

• Persistent gender disparities in operative case load and autonomy exist in surgical training, linked to implicit bias and structural barriers.
• Systemic interventions are needed, including auditing training, standardizing competency, faculty education, and trainee support.
• Addressing these inequities is vital for achieving true gender equity in surgery.