It remains unclear why female general surgery residents perform fewer cases than male peers. This exploratory study investigated possible contributors to gender-based disparities and solutions for improving equity in operative experience. 

Resident Perspectives on the Role of Gender in Operative Experience During General Surgery Residency Training: A Mixed-Methods Study

Every year hundreds of medical residents choose their specialization in various surgical fields. However, these numbers have been poorly analyzed. The objective of this study was to evaluate the selection of General and Digestive Surgery by medical residents and compare these results with the selection of other surgical specialties. Cross-sectional observational study. The data from the selection of the medical residents from surgical specialties and the top 10 most demanded specialties between the years 2018 and 2022 were included. An analysis of adjusted ranking numbers based on the number of available positions was also conducted. The number of available positions in General and Digestive Surgery increased by 17.7% during the study period. However, the selection of our specialty has been delayed, with a median ranking number of 2419 (IQR: 1621-3284) in 2018, and 3484 (IQR: 2306-4156) in 2022 (p: 0.000). These differences remained significant after adjusting for the number of available positions (p: 0.000). The choice of Urology, Thoracic Surgery, Cardiovascular Surgery, Digestive System, and Pediatrics also declined during this period, while Plastic Surgery, Dermatology, Ophthalmology, Anesthesiology, and Endocrinology improved their numbers. The choice of General and Digestive Surgery has been delayed according to the data from the MIR selection of 2018-2022. The increase in the number of available positions has not been associated with a proportional increase in demand. Cada año cientos de residentes eligen plaza en alguna de las especialidades quirúrgicas. No obstante, estos números han sido poco analizados. El objetivo de este estudio fue evaluar la elección de Cirugía General y del Aparato Digestivo por parte de los Médicos Internos Residentes (MIR), comparando estos resultados con la elección de las otras especialidades. Estudio observacional transversal. Se incluyeron los datos de la elección de los Médicos Internos Residentes (MIR) de las especialidades quirúrgicas y de las 10 especialidades más demandadas entre los años 2018 y 2022. Se realizó también un análisis de los números de orden ajustados por las plazas ofertadas. Cirugía General y del Aparato Digestivo ha aumentado un 17,7 % el número de plazas ofertadas en el periodo estudiado. Su elección se ha retrasado durante el periodo 2018 - 2022, de una mediana de número de orden de 2419 (RIQ: 1621 - 3284) en 2018 a 3484 (RIQ: 2306 - 4156) en 2022 (p: 0,000). Estas diferencias se mantuvieron al realizar el ajuste por el número de plazas ofertadas (p: 0,000). La elección de Urología, Cirugía Torácica, Cirugía Cardiovascular, Aparato Digestivo y Pediatría también decayó en este periodo, mientras que Cirugía Plástica, Dermatología, Oftalmología, Anestesiología y Endocrinología mejoraron sus números. La elección de Cirugía General y del Aparato Digestivo se ha retrasado atendiendo a los datos de la elección MIR de 2018-2022. El aumento en el número de plazas ofertadas no ha asociado un aumento proporcional de la demanda. 

Delay in the residents' choice for General and Digestive Surgery: analysis of the period 2018-2022.

INTRODUCTION
Vaginal surgery has a superior outcome profile compared with other surgical routes, yet skills are declining because of low case volumes. Graduating residents' confidence and preparedness for vaginal surgery has plummeted in the past decade. The objective of the present study was to investigate whether procedure-specific simulation skills, versus usual training, result in improved operative competence.


MATERIAL AND METHODS
We completed a randomized controlled trial of didactic and procedural training via low fidelity vaginal surgery models for anterior repair, posterior repair (PR), vaginal hysterectomy (VH), recruiting novice gynecology residents at three academic centers. We evaluated performance via global rating scale (GRS) in the real operating room and for corresponding procedures by attending surgeon blinded to group. Prespecified secondary outcomes included procedural steps knowledge, overall performance, satisfaction, self-confidence and intraoperative parameters. A priori sample size estimated 50 residents (20% absolute difference in GRS score, 25% SD, 80% power, alpha 0.05).


CLINICALTRIALS
gov: Registration no. NCT05887570.


RESULTS
We randomized 83 residents to intervention or control and 55 completed the trial (2011-23). Baseline characteristics were similar, except for more fourth-year control residents. After adjustment of confounders (age, level, baseline knowledge), GRS scores showed significant differences overall (mean difference 8.2; 95% confidence interval [CI]: 0.2-16.1; p = 0.044) and for VH (mean difference 12.0; 95% CI: 1.8-22.3; p = 0.02). The intervention group had significantly higher procedural steps knowledge and self-confidence for VH and/or PR (p < 0.05, adjusted analysis). Estimated blood loss, operative time and complications were similar between groups.


CONCLUSIONS
Compared to usual training, procedure-specific didactic and low fidelity simulation modules for vaginal surgery resulted in significant improvements in operative performance and several other skill parameters.

Procedure-specific simulation for vaginal surgery training: A randomized controlled trial.

Importance There has been an emerging trend of podcast use in medical education over the past decade. With the increasing number of podcasts and learners’ interest in trauma surgery, it is vital to validate the quality of these podcasts. Objective To determine the quantity and quality of podcast episodes on trauma surgery. Design, Setting, and Participants This cross-sectional study identified trauma surgery podcasts published globally on the Google, Apple, and Spotify platforms as of May 31, 2023. An initial screening excluded podcasts not fulfilling the inclusion criteria (published as of May 31, 2023, and covering clinical knowledge or mentorship on general trauma surgery). A 10-item checklist developed from a modified Delphi consensus method was created to assess the podcasts’ credibility, content, and design as indicators of quality. Data extracted from each podcast episode included the duration, setting, host and guest credentials, and fulfillment of quality indicators. Data were analyzed on August 13, 2023. Main Outcomes and Measures The quality of each podcast was assessed using the 10-question checklist. A score of at least 80% in credibility (4 of 5 points), 75% in content (3 of 4 points), and 100% in design (1 of 1 point) was required to classify a podcast episode as having good quality. Results The initial search identified 204 podcasts on trauma surgery, of which 55 podcasts met the inclusion criteria. All 55 podcasts were published after 2014, with the majority hosted by males (85% [61 of 72 hosts]), based in the US (91% [50 of 55 podcasts]), and focused on clinical knowledge (80% [44 of 55 podcasts]). Podcast hosts and guests predominantly held a Doctor of Medicine degree (83% [113 of 136]), with 72% [46 of 64] of guests identifying as practicing trauma surgeons. While all 55 podcasts had excellent quality in terms of content and design, 20% (11 of 55) of podcasts were rated poorly on credibility. Credibility was further reduced for 60% (33 of 55) of podcasts because of nondisclosure of conflicts of interest. Conclusions and Relevance In this cross-sectional study of trauma surgery podcasts, most had good-quality content and design, but there was a lack of explicit conflict of interest disclosure. Content producers need to disclose their conflicts of interest appropriately to ensure credibility and improve the quality of their podcasts. 

Quality of Trauma Surgery Podcasts in Credibility, Content, and Design

<h3>Objective</h3> To determine if a discrepancy exists in the number and type of cases logged between female and male urology residents. <h3>Materials and Methods</h3> ACGME case log data from 13 urology residency programs was collected from 2007 to 2020. The number and type of cases for each resident were recorded and correlated with resident gender and year of graduation. The median, 25th and 75th percentiles number of cases were calculated by gender, and then compared between female and male residents using Wilcoxon rank sum test. <h3>Results</h3> A total of 473 residents were included in the study, 100 (21%) were female. Female residents completed significantly fewer cases, 2174, compared to male residents, 2273 (<i>P</i> = .038). Analysis by case type revealed male residents completed significantly more general urology (526 vs 571, <i>P</i> = .011) and oncology cases (261 vs 280, <i>P</i> = .026). Additionally, female residents had a 1.3-fold increased odds of logging a case in the assistant role than male residents (95% confidence interval: 1.27-1.34, <i>P</i> < .001). <h3>Conclusion</h3> Gender-based disparity exists within the urology training of female and male residents. Male residents logged nearly 100 more cases than female residents over 4years, with significant differences in certain case subtypes and resident roles. The ACGME works to provide an equal training environment for all residents. Addressing this finding within individual training programs is critical. 

Gender-Based Disparity Exists in the Surgical Experience of Female and Male Urology Residents.

Objective: To examine differences in resident operative experience between male and female general surgery residents. Summary of Background Data: Despite increasing female representation in surgery, gender disparities in residency experience continue to exist. The operative volume of male and female general surgery residents has not been compared on a multi-institutional level. Methods: Demographic characteristics and case logs were obtained for categorical general surgery graduates between 2010 to 2020 from the US Resident OPerative Experience (ROPE) Consortium database. Univariable, multivariable, and linear regression analyses were performed to compare differences in operative experience between male and female residents. Results: There were 1343 graduates from 20 ACGME-accredited programs, and 476 (35%) were female. There were no differences in age, race/ethnicity, or proportion pursuing fellowship between groups. Female graduates were less likely to be high-volume residents (27% vs. 36%, P<0.01). On univariable analysis, female graduates performed fewer total cases than male graduates (1140 vs. 1177, P<0.01), largely due to a diminished surgeon junior experience (829 vs. 863, P<0.01). On adjusted multivariable analysis, female gender was negatively associated with being a high-volume resident (OR=0.74, 95% CI 0.56-0.98, P=0.03). Over the 11-year study period, the annual total number of cases increased significantly for both gender groups, but female graduates (+16 cases/year) outpaced male graduates (+13 cases/year, P=0.02) Conclusion: Female general surgery graduates performed significantly fewer cases than male graduates. Reassuringly, this gap in operative experience may be narrowing. Further interventions are warranted to promote equitable training opportunities that support and engage female residents. 

Disparities in the Operative Experience Between Female and Male General Surgery Residents

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Disparities in the Operative Experience Between Female and Male General Surgery Residents