Ophthalmology Residency: Gender and Case Volume
JAMA Ophthalmology, September 2019
The number of male and female medical students who enter ophthalmology residency programs is roughly equivalent, but little is known about differences in surgical training between these men and women. According to the Accreditation Council for Graduate Medical Education, ophthalmology residents are required to perform a specific number of surgical procedures and must receive “equivalent [training] opportunities” by gender. Data from 1999 to 2002 showed that surgical efficiency improves as case volume increases—beyond the minimum number of required cataract operations for graduation (currently 86). Even after 160 cases, operating efficiency improves and complication rates decline. In a longitudinal study, Gong et al. reviewed case logs of residents to compare surgical volume between male and female students. They found that men performed substantially more cataract operations and total procedures. The gender disparity in case volume grew throughout the 12-year timeline.
For this retrospective study, the authors collected and analyzed 12 years of data (through June 2017) for 24 U.S. ophthalmology residency programs, reflecting the experience of 1,271 residents. Details of interest were gender, parental leave status, volume of cataract operations, and total number of surgical procedures.
The analyses showed that female gender correlated with fewer cataract operations and fewer total operations. Men performed a mean (standard deviation) of 176.7 (66.2) cataract operations, whereas women performed 161.7 (56.2) (mean difference, –15.0; p < .001). The mean number of total procedures was 509.4 (208.6) for men and 451.3 (158.8) for women (mean difference, –58.1; p < .001). Eighty-five (10.4%) of the 815 male residents and 71 (15.6%) of the 456 female residents took parental leave. On average, male residents who took paternity leave performed a mean of 27.5 more cataract operations than the men who did not take leave (p < .001). However, the case volume of female residents who took maternity leave was similar to that of women who did not (mean difference, –2.0; p = .81). From 2005 to 2017, the increase in total number of procedures was greater for men than for women (β = –8.0; p = .008).
Educators should be aware of this gender disparity, and further investigation is needed to ensure that training experiences truly are equivalent, the authors noted. (Also see related commentary by Julia A. Haller, MD, and Qiang Zhang, PhD, in the same issue.)
The original article can be found here.