Resident Operative Autonomy and Attending Verbal Feedback Differ by Resident and Attending Gender

Amanda C Filiberto; Kenneth L Abbott; Benjamin Shickel; Brian C George; Amalia L Cochran; George A Sarosi Jr; Gilbert R Upchurch Jr; Tyler J Loftus

doi:10.1097/AS9.0000000000000256

Resident Operative Autonomy and Attending Verbal Feedback Differ by Resident and Attending Gender

Ann Surg Open. 2023 Feb 2;4(1):e256. doi: 10.1097/AS9.0000000000000256. eCollection 2023 Mar.

Authors

Amanda C Filiberto¹, Kenneth L Abbott¹, Benjamin Shickel², Brian C George³, Amalia L Cochran¹, George A Sarosi Jr¹, Gilbert R Upchurch Jr¹, Tyler J Loftus¹

Affiliations

¹ From the Department of Surgery, University of Florida Health, Gainesville, FL.
² Department of Medicine, University of Florida Health, Gainesville, FL.
³ Department of Learning Health Sciences, University of Michigan, Ann Arbor, MI.

Abstract

Objectives: This study tests the null hypotheses that overall sentiment and gendered words in verbal feedback and resident operative autonomy relative to performance are similar for female and male residents.

Background: Female and male surgical residents may experience training differently, affecting the quality of learning and graduated autonomy.

Methods: A longitudinal, observational study using a Society for Improving Medical Professional Learning collaborative dataset describing resident and attending evaluations of resident operative performance and autonomy and recordings of verbal feedback from attendings from surgical procedures performed at 54 US general surgery residency training programs from 2016 to 2021. Overall sentiment, adjectives, and gendered words in verbal feedback were quantified by natural language processing. Resident operative autonomy and performance, as evaluated by attendings, were reported on 5-point ordinal scales. Performance-adjusted autonomy was calculated as autonomy minus performance.

Results: The final dataset included objective assessments and dictated feedback for 2683 surgical procedures. Sentiment scores were higher for female residents (95 [interquartile range (IQR), 4-100] vs 86 [IQR 2-100]; P < 0.001). Gendered words were present in a greater proportion of dictations for female residents (29% vs 25%; P = 0.04) due to male attendings disproportionately using male-associated words in feedback for female residents (28% vs 23%; P = 0.01). Overall, attendings reported that male residents received greater performance-adjusted autonomy compared with female residents (P < 0.001).

Conclusions: Sentiment and gendered words in verbal feedback and performance-adjusted operative autonomy differed for female and male general surgery residents. These findings suggest a need to ensure that trainees are given appropriate and equitable operative autonomy and feedback.

Keywords: autonomy; feedback; gender; natural language processing; residency; surgery.