Differences Between Male and Female Residents in Case Volumes and Learning in Cataract Surgery

Abstract

Objective: It is important that ophthalmology residency programs are structured to provide opportunities for all residents to gain adequate surgical experience. The aim of this study is to examine differences between female and male residents in number of cataract surgeries performed, surgical outcomes, and rate of learning, and to draw implications for the training of ophthalmology residents.

Design: In this hospital-based retrospective cohort study we examined the cumulative number of surgeries performed, and the intraoperative complications rate, of male and female residents over time. We used multivariable regression to measure the association between cataract surgery volumes and resident gender, controlling for covariates. We compared the intraoperative complications rates of female and male residents in each quarter of the program and overall, and estimated a multivariable logistic model of intraoperative complications with resident gender, surgical experience, their interaction, and other predictors.

Setting: Three-year residency programs at 5 Aravind Eye Hospitals in India.

Participants: Residents entering in 2012, 2013, 2014, or 2015.

Results: In our sample of 95 residents (64 females, 31 males), a male resident on average performed 662.2 surgeries, which was 26.9% (p < 0.05) more than the 521.8 surgeries performed by a female resident. The difference in cumulative case volume grew steadily during the residency, and was not explained by the 29 more days of leave taken by female residents. On average a male resident performed 21% more surgeries per surgical turn than a female resident. In each quarter female residents had a lower cumulative rate of intraoperative complications than males, but the differences were not statistically significant. Learning curve analysis showed that the effect of experience on intraoperative complications flattened at about 300 surgeries, and that the curves for male and female residents were not statistically different.

Conclusion: Female residents performed substantially fewer surgeries than their male counterparts in our data. However, surgical outcomes were comparable between groups with complication rates flattening after 300 surgeries for all trainees.

Keywords: Ophthalmology; cataract; eye; gender; learning; residents; surgery.