Gender Differences in Autonomy and Performance Assessments in a National Cohort of Vascular Surgery Trainees

INTRODUCTION Gender disparities in surgical training and assessment are described in the general surgery literature. Assessment disparities have not been explored in vascular surgery. We sought to investigate gender disparities in operative assessment in a national cohort of vascular surgery integrated residents (VIR) and fellows (VSF). METHODS Operative performance and autonomy ratings from the Society for Improving Medical Professional Learning (SIMPL) application database were collected for all vascular surgery participating institutions from 2018-2023. Logistic generalized linear mixed models were conducted to examine the association of faculty and trainee gender on faculty and self-assessment of autonomy and performance. Data were adjusted for post-graduate year and case complexity. Random effects were included to account for clustering effects due to participant, program, and procedure. RESULTS 103 trainees (n=63 VIR, n=40 VSF; 63.1% men) and 99 faculty (73.7% men) from 17 institutions (n=12 VIR and 13 VSF programs) contributed 4,951 total assessments (44.4% by faculty, 55.6% by trainees) across 235 unique procedures. Faculty and trainee gender were not associated with faculty ratings of performance (OR 0.78 [95% CI: 0.27-2.29] faculty gender; OR 1.80 [95% CI: 0.76-0.43] trainee gender) or autonomy (OR 0.99 [95% CI: 0.41-2.39] faculty gender; OR 1.23 [95% CI: 0.62-2.45] trainee gender) of trainees. All trainees self-assessed at lower performance and autonomy ratings as compared with faculty assessments. However, women trainees rated themselves significantly lower than men for both autonomy (OR 0.57 [95% CI: 0.43-0.74]) and performance (OR 0.40 [95% CI: 0.30-0.54]). CONCLUSIONS Although gender was not associated with differences in faculty assessment of performance or autonomy amongst vascular surgery trainees, women trainees perceive themselves as performing with lower competency and less autonomy than their male colleagues. These findings suggest utility for exploring gender differences in real-time feedback delivered to and received by trainees, and targeted interventions to align trainee self-perception with actual operative performance and autonomy to optimize surgical skill acquisition.