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Differences in Operative Self-Assessment Between Male and Female Plastic Surgery Residents: A Survey of 8149 Cases
Carisa M. Cooney, MPH1; Pathik Aravind1; Scott D. Lifchez, MD1; C. Scott Hultman, MD, MBA, FACS1,2; Robert A. Weber, MD3; Sabastian Brooke, MD; Damon S. Cooney, MD, PhD1 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 of resident physicians have shown that male and female residents rate their work performance differently, with women tending to underrate and men tending to overrate their own performance. We performed the current study to determine if plastic surgery resident trainee self-evaluations differed by resident sex.

Methods: Operative Entrustability Assessment (OEA) data were abstracted from MileMarkerTM, a web-based program capable of storing trainee self-assessments and their associated attending assessments of any CPT-coded procedure. Ratings are based on a 5-point scale where 1="observed case" and 5="can take junior resident through case." All OEAs completed by plastic surgery programs at three institutions were extracted. Complete OEAs are defined as those containing a self-assessment by the trainee (plastic surgery resident) and an evaluation from an attending surgeon. We used linear regression to assess differences between trainee and attending scores by trainee sex and post-graduate year (PGY).

Results: We included 8,149 OEAs from 3 training programs for the entire period of each program’s MileMarker use. OEAs were completed by 64 unique residents, of whom 25% were female, and 51 unique attending surgeons (29% female). Unadjusted analysis showed that male residents’ self-assessment scores were higher (mean=3.57, 95% CI: 3.55-3.60) than female residents’ self-assessment scores (mean=2.85, 95% CI: 2.80-2.91). When comparing residents’ self-evaluations to the attending’s evaluations, male residents’ self-evaluation scores were higher than the attendings’ scores (mean=3.48, 95% CI: 3.46-3.51) and female residents’ self-evaluation scores were lower than the attendings’ scores (mean=3.15, 95% CI: 3.08-3.20). After adjusting for PGY, both male and female residents’ self-assessment scores were below attendings’ scores (p<0.001); however, female residents’ self-assessment scores remained lower than their male counterparts.

Conclusion: Our dataset including 4.5 years of data from 3 plastic surgery training programs showed that female plastic surgery residents underestimated and male residents overestimated their performance as compared to attending assessments. This effect persisted after adjusting for PGY. Further studies are needed to determine reasons for these differences.

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