Gender-Based Differences in Surgical Residents' Perceptions of Patient Safety, Continuity of Care, and Well-Being: An Analysis from the Flexibility in Duty Hour Requirements for Surgical Trainees (FIRST) Trial

J Am Coll Surg. 2017 Feb;224(2):126-136.e2. doi: 10.1016/j.jamcollsurg.2016.10.043. Epub 2016 Nov 21.


Background: Little is known about gender differences in residency training experiences and whether duty hour policies affect these differences. Using data from the Flexibility in Duty Hour Requirements for Surgical Trainees (FIRST) trial, we examined gender differences in surgical resident perceptions of patient safety, education, health and well-being, and job satisfaction, and assessed whether duty hour policies affected gender differences.

Study design: We compared proportions of male and female residents expressing dissatisfaction or perceiving a negative effect of duty hours on aspects of residency training (ie patient safety, resident education, well-being, job satisfaction) overall and by PGY. Logistic regression models with robust clustered SEs were used to test for significant gender differences and interaction effects of duty hour policies on gender differences.

Results: Female PGY2 to 3 residents were more likely than males to be dissatisfied with patient safety (odds ratio [OR] = 2.50; 95% CI, 1.29-4.84) and to perceive a negative effect of duty hours on most health and well-being outcomes (OR = 1.51-2.10; all p < 0.05). Female PGY4 to 5 residents were more likely to be dissatisfied with resident education (OR = 1.56; 95% CI, 1.03-2.35) and time for rest (OR = 1.55; 95% CI, 1.05-2.28) than males. Flexible duty hours reduced gender differences in career dissatisfaction among interns (p = 0.028), but widened gender differences in negative perceptions of duty hours on patient safety (p < 0.001), most health and well-being outcomes (p < 0.05), and outcomes related to job satisfaction (p < 0.05) among PGY2 to 3 residents.

Conclusions: Gender differences exist in perceptions of surgical residency. These differences vary across cohorts and can be influenced by duty hour policies.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Attitude of Health Personnel*
  • Continuity of Patient Care
  • Female
  • General Surgery / education*
  • General Surgery / organization & administration
  • Humans
  • Internship and Residency / organization & administration*
  • Job Satisfaction
  • Logistic Models
  • Male
  • Occupational Health
  • Patient Safety
  • Personnel Staffing and Scheduling / standards*
  • Practice Guidelines as Topic
  • Sex Factors
  • United States
  • Workload / standards*