The correlation between trainee gender and operative autonomy during trauma and orthopaedic training in Ireland and the UK

Listen to Simon and Amy discuss the paper 'The correlation between trainee gender and operative autonomy during trauma and orthopaedic training in Ireland and the UK' published in the January 2025 issue of Bone & Joint Open.

Click here to read the paper.

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Transcript

[00:00:00] Welcome back to another episode of AI Talks with Bone & Joint from the publishers of Bone & Joint Open. Today we are discussing the paper, 'The correlation between trainee gender and operative autonomy during trauma and orthopaedic training in Ireland and the UK', published in January 2025 by R. McColgan, F. Boland, G. A. Sheridan, G. Colgan, D. Bose, D. M. Eastwood and D. M. Dalton. I am Simon, and I am joined by my co-host, Amy. 

Hello everyone. I am really looking forward to delving into this topic today. This study provides some compelling insights into the correlation between gender and operative autonomy in orthopaedic training.

The objective of this study was to explore differences in operative autonomy based on trainee gender in Ireland and the UK. It was a retrospective cohort study, examining all operations recorded by orthopaedic trainees over a decade, from July 2012 to July 2022. 

The primary outcome they examined was operative autonomy, [00:01:00] defined as the trainee performing the operation without the supervising trainer scrubbed in. It is a straightforward metric, but crucial for understanding the level of independence these trainees have. 

Quite right. They included an impressive 3,533,223 operations in their analysis, which is a substantial data set. They found that, on average, male trainees performed 5% more operations with autonomy than female trainees, 30.5 percent compared to 25.5%. 

That is a rather noticeable difference. They also observed that female trainees assisted in 3% more operations and performed 2% more operations with a supervising trainer scrubbed in. What's particularly fascinating is that these differences were consistent across all years of training, different complexities of cases, specialty areas and specific procedures.

The only exception was nerve decompression, where no significant gender difference was noted. When the authors adjusted for year, training level, [00:02:00] complexity of the case, specialty area and urgency, male trainees still had significantly higher odds of performing an operation with autonomy, 145% increased odds to be precise. Even under trainer supervision, males had a 35% increased odds compared to their female counterparts. 

We should also mention the secondary findings. The authors examined how these differences emerged year by year. For instance, the greatest difference in autonomy between male and female trainees was observed in the fifth year of specialty training where male trainees performed 6% more operations autonomously. 

Yes, and by the eighth year, the gap reduced to 3%, but that remained significant. Furthermore, the study found that female trainees assist more at every stage of their training, except in the eighth year, where the difference is negligible.

The authors also analysed the cases based on their complexity and found that male trainees performed a higher percentage of major operations autonomously, [00:03:00] 6% more than female trainees. For complex major operations, male trainees not only performed more autonomously, but also performed more under trainer supervision. Thus, female trainees ended up assisting more in the most complex cases. These findings were consistent across various specialty areas. In knee and lower leg specialties for instance, male trainees performed 7% more operations autonomously. The smallest difference was in pelvis and acetabulum, but even there, male trainees had a 2% lead.

The study also explores potential reasons for these disparities, such as the perception of lower autonomy among female trainees. This perception could be influenced by various factors, including lower trust from trainers, patients and staff. 

The study discusses how female trainees tend to rate themselves lower in terms of autonomy compared to their male counterparts. Trainer entrustment plays a significant role here. If trainers are less likely to entrust female trainees with autonomy, it could reflect in the trainees lower [00:04:00] self-assessment. 

Another intriguing aspect is the impact of these differences on training duration and burnout. Female trainees, owing to these autonomy differences, might require 2.16 to 3.6 additional months of training. Less autonomy could also lead to higher burnout and attrition rates among female trainees. 

Indeed, one of the strengths of this study was its extensive data set, covering ten years, and including all orthopaedic specialists in both countries. However, it did have limitations, such as the recording of supervision levels by the trainees themselves, which could introduce some bias.

It is a comprehensive piece of research that urges the training bodies in Ireland and the UK to address these gender based disparities and work towards more equitable training conditions. Tackling these issues could enhance the overall quality of training and even improve patient outcomes. 

Absolutely. In summary, gender disparities exist in operative autonomy for orthopaedic trainees in Ireland and the UK, with male trainees generally obtaining more [00:05:00] autonomous opportunities. The causes may be multifaceted, but the impact is clear and needs addressing. Indeed. And on that note, we have reached the end of today's episode.

Thank you for tuning in, everyone. We hope you found the discussion insightful. Do join us next time for another deep dive into cutting edge orthopaedic research. 

Thank you, everyone. Until next time.