Gender Differences in Autonomy Granted to Residents and Fellows During Procedural Training: A Systematic Review and Meta-Analysis

Sarah Lund; Elaine M Griffeth; Andrea Williamson; Amelia Collings; Hallbera Gudmundsdottir; Amy Han; LaDonna Kearse; Ian M Kratzke; Parvathi Wilkins; Larry J Prokop; David A Cook

doi:10.1097/ACM.0000000000005673

Gender Differences in Autonomy Granted to Residents and Fellows During Procedural Training: A Systematic Review and Meta-Analysis

Acad Med. 2024 Feb 27. doi: 10.1097/ACM.0000000000005673. Online ahead of print.

Authors

Affiliations

¹ S. Lund is a general surgery resident and assistant professor of medical education, Mayo Clinic, Rochester, Minnesota; ORCID: https://orcid.org/0000-0003-2214-5916.
² E.M. Griffeth is a general surgery resident, Mayo Clinic, Department of Surgery, Rochester, Minnesota; ORCID: https://orcid.org/0000-0002-0425-2710.
³ A. Williamson is a general surgery resident, University of Utah Hospital, Department of Surgery, Salt Lake City, Utah; ORCID: https://orcid.org/0000-0002-6676-9651.
⁴ A. Collings is a general surgery resident, University of Louisville School of Medicine, Department of Surgery, Louisville, Kentucky; ORCID: https://orcid.org/0000-0003-4534-0116.
⁵ H. Gudmundsdottir is a general surgery resident, Mayo Clinic, Department of Surgery, Rochester, Minnesota; ORCID: https://orcid.org/0000-0002-1297-2769.
⁶ A. Han is a general surgery resident, Cleveland Clinic, Department of Surgery, Cleveland, Ohio; ORCID: https://orcid.org/0000-0002-7862-4177.
⁷ L. Kearse is a general surgery resident, Mayo Clinic, Department of Surgery, Rochester, Minnesota; ORCID: https://orcid.org/0000-0002-3076-8374.
⁸ I.M. Kratzke is a general surgery resident, University of North Carolina Department of Surgery, Chapel Hill, North Carolina; ORCID: https://orcid.org/0000-0001-6849-4412.
⁹ P. Wilkins is a simulation fellow, Mayo Clinic, Multidisciplinary Simulation Center, Rochester, Minnesota; ORCID: https://orcid.org/0000-0002-8606-1714.
¹⁰ L.J. Prokop is a librarian, Mayo Clinic, Rochester, Minnesota; ORCID: https://orcid.org/0000-0002-7197-7260.
¹¹ D.A. Cook is professor of medicine and medical education; director of education science, Office of Applied Scholarship and Education Science, Mayo Clinic College of Medicine and Science; and consultant, Division of General Internal Medicine, Mayo Clinic, Rochester, Minnesota. ORCID: https://orcid.org/0000-0003-2383-4633.

PMID: 38412483
DOI: 10.1097/ACM.0000000000005673

Abstract

Purpose: Supervisors may be prone to implicit (unintentional) bias when granting procedural autonomy to trainees due to the subjectivity of autonomy decisions. The authors aimed to conduct a systematic review and meta-analysis to assess the differences in perceptions of procedural autonomy granted to physician trainees based on gender and/or race.

Method: MEDLINE, Embase, CENTRAL, Scopus, and Web of Science were searched (search date: January 5, 2022) for studies reporting quantitative gender- or race-based differences in perceptions of procedural autonomy of physician trainees. Reviewers worked in duplicate for article selection and data abstraction. Primary measures of interest were self-reported and observer-rated procedural autonomy. Meta-analysis pooled differences in perceptions of procedural autonomy based on trainee gender.

Results: The search returned 2,714 articles, of which 16 were eligible for inclusion. These reported data for 6,109 trainees (median 90 per study) and 2,763 supervisors (median 54 per study). No studies investigated differences in perceptions of autonomy based on race. In meta-analysis of disparities between genders in autonomy ratings (positive number favoring female trainees), pooled standardized mean differences were -0.12 (95% confidence interval [CI] = -0.19, -0.04; P = .003; n = 10 studies) for trainee self-rated autonomy and -0.05 (95% CI = -0.11, 0.01; P = .07; n = 9 studies) for supervisor ratings of autonomy.

Conclusions: Limited evidence suggests that female trainees perceived that they received less procedural autonomy than did males. Further research exploring the degree of gender- and race-based differences in procedural autonomy, and factors that influence these differences, is warranted.