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Gender Bias in Plastic Surgery Resident Assessment: A Survey of 8,149 Cases
Carisa M. Cooney, MPH1; Pathik Aravind1; C. Scott Hultman, MD, MBA, FACS1,2; Robert A. Weber, MD3; Sabastian Brooke, MD3; Damon S. Cooney, MD, PhD1; Scott D. Lifchez, MD1 1Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, MD 2Division of Plastic and Reconstructive Surgery, University of North Carolina School of Medicine, Chapel Hill, NC 3Division of Plastic and Reconstructive Surgery, Baylor Scott & White Medical Center, Temple, TX

Background: Previous studies have shown that male and female attendings rate or provide operating room (OR) autonomy differently to male and female residents, with male attendings providing higher ratings and more OR autonomy to male residents. We conducted the current study to determine if plastic surgery resident trainees are evaluated differently according to attending physician sex.

Methods: Operative Entrustability Assessment (OEA) data were abstracted from MileMarkerTM, a web-based program capable of storing trainee operative skill assessments of any CPT-coded procedure. Ratings are based on a 5-point scale (1="observed case" and 5="can take junior resident through case"). We extracted all complete OEAs (those containing self-assessments and attending evaluations) from three institutions. We used linear regression adjusting for post-graduate year (PGY) to compare male and female attendings’ assessments of male and female residents.

Results: We included 8,149 OEAs completed by 64 unique residents (25% female) and 51 unique attendings (29% female). Adjusted analysis showed that male attendings rated female residents significantly lower than male residents (p<0.001, 95%CI= -0.311 to -0.197). Scores by female attendings demonstrated no significant difference between male and female residents (p=0.067, 95%CI= -0.198 to 0.007).

Conclusion: Our dataset including 4.5 years of data from three training programs showed that female plastic surgery residents are scored lower than their male counterparts by male attendings. As plastic surgery begins its pilot of competency-based training, further studies are needed to determine reasons for these differences to ensure appropriate advancement of all trainees.

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