Kearse, LaDonna E

Abstract Purpose Supervisors may be prone to implicit (unintentional) bias when granting procedural autonomy to trainees due to the subjectivity of autonomy decisions. The authors aimed to conduct a systematic review and meta-analysis to assess the differences in perceptions of procedural autonomy granted to physician trainees based on gender and/or race. Method MEDLINE, Embase, CENTRAL, Scopus, and Web of Science were searched (search date: January 5, 2022) for studies reporting quantitative gender- or race-based differences in perceptions of procedural autonomy of physician trainees. Reviewers worked in duplicate for article selection and data abstraction. Primary measures of interest were self-reported and observer-rated procedural autonomy. Meta-analysis pooled differences in perceptions of procedural autonomy based on trainee gender. Results The search returned 2,714 articles, of which 16 were eligible for inclusion. These reported data for 6,109 trainees (median, 90 per study) and 2,763 supervisors (median, 54 per study). No studies investigated differences in perceptions of autonomy based on race. In meta-analysis of disparities between genders in autonomy ratings (positive number favoring female trainees), pooled standardized mean differences were −0.12 (95% confidence interval [CI], −0.19 to −0.04; P = .003; n = 10 studies) for trainee self-rated autonomy and −0.05 (95% CI, −0.11 to 0.01; P = .07; n = 9 studies) for supervisor ratings of autonomy. Conclusions Limited evidence suggests that female trainees perceived that they received less procedural autonomy than did males. Further research exploring the degree of gender- and race-based differences in procedural autonomy, and factors that influence these differences is warranted.

Background A national survey of general surgery residents revealed significant self-assessed deficits in preparation for independent practice, with only 7.7% of graduating postgraduate year 5 residents (n=1145) reporting self-efficacy for all 10 commonly performed operations surveyed. Objective We sought to understand why this phenomenon occurs. We hypothesized that self-efficacy would be positively correlated with both operative independence and case volume. Methods We compared 3 independent datasets: case information for the same 10 previously surveyed operations for residents graduating in 2020 (dataset 1), operative independence data obtained through the SIMPL OR app, an operative self-assessment tool (dataset 2), and case volume data obtained through the Accreditation Council for Graduate Medical Education National Data Report (dataset 3). Operations were categorized into high, middle (mid), and low self-efficacy tiers; analysis of variance was used to compare operative independence and case volume per tier. Results There were significant differences in self-efficacy between high (87.7%), mid (68.3%), and low (25.4%) tiers ( P =.008 [95% CI 6.2, 32.7] for high vs mid, P <.001 for high vs low [49.1, 75.6], and P <.001 for mid vs low [28.7, 57.1]). The percentage of cases completed with operative independence followed similar trends (high 32.7%, mid 13.8%, low 4.9%, P =.006 [6.4, 31.4] for high vs mid, P <.001 [15.3, 40.3] for high vs low, P =.23 [-4.5, 22.3] for mid vs low). The total volume of cases decreased from high to mid to low self-efficacy tiers (average 91.8 to 20.8 to 11.1) but did not reach statistical significance on post-hoc analysis. Conclusions In this analysis of US surgical residents, operative independence was strongly correlated with self-efficacy.