Subscribe to RSS
DOI: 10.1055/a-2181-6921
Video-Based Assessment of Microsurgical Trainees: An Evaluation of Gender Bias
![](https://www.thieme-connect.de/media/jrm/202405/lookinside/thumbnails/10-1055-a-2181-6921_23030064-1.jpg)
Abstract
Background Gender bias in graduate medical evaluations remains a challenging issue. This study evaluates implicit gender bias in video-based evaluations of microsurgical technique, which has not previously been described in the literature.
Methods Two videos were recorded of microsurgical anastomosis; the first was performed by a hand/microsurgery fellow and the second by an expert microsurgeon. A total of 150 surgeons with microsurgical experience were recruited to evaluate the videos; they were told these videos depicted a surgical trainee 1 month into fellowship followed by the same trainee 10 months later. The only variable was the name (“Rachel” or “David”) that each participant was randomly assigned to evaluate. Participants were asked to score each video for quality, technique, efficiency, as well as overall progression and development after the second video compared with the initial video. To focus on bias, these outcome measures were selected to be purposefully subjective and all ratings were based on a subjective 1to 10 scale (10 = excellent).
Results The analysis included 150 participants (75% male). There were no statistically significant differences in scores between the “female” and “male” trainee. The trainees received the same median initial (1-month video) and final (11th-month video) scores for all criteria except initial technique, in which the female trainee received a 7 and the male trainee received an 8. Notably, 11-month scores were consistently the same or lower than 1-month scores for both study groups (p < 0.001). There were also no differences within either study group based on participant sex. Microsurgery practitioners overall rated both groups lower than those who do not currently practice microsurgery.
Conclusion Our study did not identify a gender bias in this evaluation method. Further investigation into how we assess and grade trainees as well as the presence and impact of implicit biases on varying surgical assessment methods is warranted.
Publication History
Received: 21 March 2023
Accepted: 18 September 2023
Accepted Manuscript online:
26 September 2023
Article published online:
03 November 2023
© 2023. Thieme. All rights reserved.
Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA
-
References
- 1 The Majority of U.S. Medical Students Are Women, New Data Show. Association of American Medical Colleges; . Accessed August 20, 2020 at: https://www.aamc.org/news-insights/press-releases/majority-us-medical-students-are-women-new-data-show
- 2 Bae GH, Lee AW, Park DJ, Maniwa K, Zurakowski D, Day CS. ASSH Diversity Committee. Ethnic and gender diversity in hand surgery trainees. J Hand Surg Am 2015; 40 (04) 790-797
- 3 Chen W, Baron M, Bourne DA, Kim JS, Washington KM, De La Cruz C. A report on the representation of women in academic plastic surgery leadership. Plast Reconstr Surg 2020; 145 (03) 844-852
- 4 Bernardi K, Shah P, Lyons NB. et al. Perceptions on gender disparity in surgery and surgical leadership: a multicenter mixed methods study. Surgery 2020; 167 (04) 743-750
- 5 Klein R, Julian KA, Snyder ED. et al; From the Gender Equity in Medicine (GEM) workgroup. Gender bias in resident assessment in graduate medical education: review of the literature. J Gen Intern Med 2019; 34 (05) 712-719
- 6 Applebaum MA, Doren EL, Ghanem AM, Myers SR, Harrington M, Smith DJ. Microsurgery competency during plastic surgery residency: an objective skills assessment of an integrated residency training program. Eplasty 2018; 18: e25
- 7 McGoldrick RB, Davis CR, Paro J, Hui K, Nguyen D, Lee GK. Motion analysis for microsurgical training: objective measures of dexterity, economy of movement, and ability. Plast Reconstr Surg 2015; 136 (02) 231e-240e
- 8 Rajan S, Sathyan R, Sreelesh LS. et al. Objective assessment of microsurgery competency-in search of a validated tool. Indian J Plast Surg 2019; 52 (02) 216-221
- 9 Ramachandran S, Ghanem AM, Myers SR. Assessment of microsurgery competency-where are we now?. Microsurgery 2013; 33 (05) 406-415
- 10 Klein R, Ufere NN, Rao SR. et al; Gender Equity in Medicine workgroup. Association of gender with learner assessment in graduate medical education. JAMA Netw Open 2020; 3 (07) e2010888
- 11 Anderson JE, Zern NK, Calhoun KE, Wood DE, Smith CA. Assessment of potential gender bias in general surgery resident milestone evaluations. JAMA Surg 2022; 157 (12) 1164-1166
- 12 Dayal A, O'Connor DM, Qadri U, Arora VM. Comparison of male vs female resident milestone evaluations by faculty during emergency medicine residency training. JAMA Intern Med 2017; 177 (05) 651-657
- 13 Gerull KM, Loe M, Seiler K, McAllister J, Salles A. Assessing gender bias in qualitative evaluations of surgical residents. Am J Surg 2019; 217 (02) 306-313
- 14 McQueen S, McKinnon V, VanderBeek L, McCarthy C, Sonnadara R. Video-based assessment in surgical education: a scoping review. J Surg Educ 2019; 76 (06) 1645-1654
- 15 Salles A, Awad M, Goldin L. et al. Estimating implicit and explicit gender bias among health care professionals and surgeons. JAMA Netw Open 2019; 2 (07) e196545
- 16 Phillips NA, Tannan SC, Kalliainen LK. Understanding and overcoming implicit gender bias in plastic surgery. Plast Reconstr Surg 2016; 138 (05) 1111-1116
- 17 Brienza RS, Huot S, Holmboe ES. Influence of gender on the evaluation of internal medicine residents. J Womens Health (Larchmt) 2004; 13 (01) 77-83
- 18 Holmboe ES, Huot SJ, Brienza RS, Hawkins RE. The association of faculty and residents' gender on faculty evaluations of internal medicine residents in 16 residencies. Acad Med 2009; 84 (03) 381-384
- 19 Ringdahl EN, Delzell JE, Kruse RL. Evaluation of interns by senior residents and faculty: is there any difference?. Med Educ 2004; 38 (06) 646-651
- 20 Ong TQ, Kopp JP, Jones AT, Malangoni MA. Is there gender bias on the American Board of Surgery General surgery certifying examination?. J Surg Res 2019; 237: 131-135
- 21 Kwasny L, Shebrain S, Munene G, Sawyer R. Is there a gender bias in milestones evaluations in general surgery residency training?. Am J Surg 2021; 221 (03) 505-508
- 22 Flyckt RL, White EE, Goodman LR, Mohr C, Dutta S, Zanotti KM. The use of laparoscopy simulation to explore gender differences in resident surgical confidence. Obstet Gynecol Int 2017; 2017: 1945801
- 23 Salles A, Mueller CM, Cohen GL. A values affirmation intervention to improve female residents' surgical performance. J Grad Med Educ 2016; 8 (03) 378-383
- 24 Salles A, Mueller CM, Cohen GL. Exploring the relationship between stereotype perception and residents' well-being. J Am Coll Surg 2016; 222 (01) 52-58
- 25 Hoops H, Heston A, Dewey E, Spight D, Brasel K, Kiraly L. Resident autonomy in the operating room: does gender matter?. Am J Surg 2019; 217 (02) 301-305
- 26 Joh DB, van der Werf B, Watson BJ. et al. Assessment of autonomy in operative procedures among female and male New Zealand general surgery trainees. JAMA Surg 2020; 155 (11) 1019-1026
- 27 Meyerson SL, Odell DD, Zwischenberger JB. et al; Procedural Learning and Safety Collaborative. The effect of gender on operative autonomy in general surgery residents. Surgery 2019; 166 (05) 738-743
- 28 Shellito AD, de Virgilio C, Lee G. et al; Surgery Educators Workgroup. Investigating association between sex and faculty teaching evaluation in general surgery residency programs: a multi-institutional study. J Am Coll Surg 2020; 231 (03) 309-315.e1
- 29 Lane SM, Young KA, Hayek SA. et al. Meaningful autonomy in general surgery training: exploring for gender bias. Am J Surg 2020; 219 (02) 240-244
- 30 Skjold-Ødegaard B, Ersdal HL, Assmus J, Soreide K. Comparison of performance score for female and male residents in general surgery doing supervised real-life laparoscopic appendectomy: is there a Norse Shield-maiden effect?. World J Surg 2021; 45 (04) 997-1005
- 31 Sudario-Lumague R, Chiang YC, Lin TS. Gender comparison of medical student microsurgical skills in a laboratory model. J Reconstr Microsurg 2018; 34 (05) 359-362
- 32 Govaerts MJ, Schuwirth LW, Van der Vleuten CP, Muijtjens AM. Workplace-based assessment: effects of rater expertise. Adv Health Sci Educ Theory Pract 2011; 16 (02) 151-165
- 33 Yeates P, O'Neill P, Mann K, Eva KW. Effect of exposure to good vs poor medical trainee performance on attending physician ratings of subsequent performances. JAMA 2012; 308 (21) 2226-2232
- 34 Abelson JS, Chartrand G, Moo TA, Moore M, Yeo H. The climb to break the glass ceiling in surgery: trends in women progressing from medical school to surgical training and academic leadership from 1994 to 2015. Am J Surg 2016; 212 (04) 566-572.e1
- 35 Plana NM, Khouri KS, Motosko CC. et al. The evolving presence of women in academic plastic surgery: a study of the past 40 years. Plast Reconstr Surg 2018; 141 (05) 1304-1310