Gender-associated differences in entrustability and feedback in general surgery residency

Entrustable professional activities were developed to enhance competency-based performance assessments for general surgery trainees. We sought to examine the impact of gender on entrustable professional activity evaluations, with emphasis on entrustability and narrative feedback quality.

We conducted a retrospective study of entrustable professional activity evaluations collected from July 2023 to November 2025 at a single institution. Ordinal logistic regression and mixed-effects models were used to assess the impact of gender. The Quality of Assessment for Learning tool was used to grade written feedback quality. Narrative comments were analyzed using directed content analysis to identify competencies addressed.

A total of 3,077 entrustable professional activity evaluations were collected from 94 faculty (40% female) evaluating 55 residents (72% female). Increasing resident postgraduate year level and decreasing case complexity were significantly associated with higher faculty-assigned entrustability scores (P < .001 and P < .01). Neither resident nor faculty gender was significantly associated with faculty-assigned entrustability ratings (P = .85 and P = .08). However, female residents reported lower self-ratings of entrustability (P < .001) than their male peers. Among the entrustable professional activity feedback comments, patient care was the most frequently addressed competency and was present more frequently than other core competencies such as medical knowledge or interpersonal and communication skills. Overall, the mean Quality of Assessment for Learning score was 2.76 out of 5. Female attendings provided feedback more often (P < .01). In addition, female faculty provided significantly longer and higher-quality narrative comments (mean Quality of Assessment for Learning score of 3.24 vs 2.34 for their male counterparts, P = .001).

Although female general surgery residents reported lower self-assigned entrustability, neither resident nor faculty gender was an independent predictor of faculty-rated entrustability. Overall narrative feedback quality was low; however, female faculty provided higher-quality feedback. These findings underscore the importance of identifying specific metrics that inform resident entrustability and the need for continuous improvement in faculty feedback.