Who Gets to Hold the Knife? Gender and Autonomy in (Australian) Surgical Training

Purpose Over the past decade there has been an increased focus on equality and diversity in surgical training globally. There is little doubt that increased diversity and representation leads to better healthcare outcomes; despite this, females account for only 12% of general surgeons in Australia. This study aimed to examine gender differences in autonomous operating of trainee general surgeons as a means of gaining insight to one aspect of the lived experience of female surgeons. Methods The study design was a retrospective cohort analysis of all general surgical trainees in Australia from 2013 to 2020. Data comprised self-reported, online logbook data (Morbidity Audit and Logbook Tool MALT) that is mandatory for all surgical trainees. Meaningful autonomy (MA) was defined as operating without a senior surgeon scrubbed. Operations were categorised as ‘minor operations’, ‘major operations’ and ‘endoscopy’ as defined by RACS and the online data recording tool MALT Results were analysed using SPSS for Windows with a paired t-test for all operations, major operations, minor operations and endoscopy. Due to the large data set and 2014 outlier data a Cohen’s d test of practical significance was also calculated. Results There were >1.3m logbook entries from 2,783 trainees (female=1,033; male=1,750) Procedures included ‘minor operations’, ‘major operations’ and ‘endoscopy’. Throughout their training, females had a significantly lower MA for procedures compared with their male peers (39.7% vs 42.2% t ₇ =7.861 sig <.001). Cohen’s d analysis indicates a large effect size and practical significance (8.9). For major and minor operating combined (excluding endoscopy), the greatest difference in MA was in 2020 (10%) and the smallest in 2014 (2.1%). Conclusions This large dataset of general surgical trainees’ logbook entries shows that females have fewer opportunities for meaningful autonomy during training. This difference may contribute to lower recruitment, retention and confidence expressed by female surgeons in Australia.