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Halsted's Hands - Self-Confidence, Autonomy and Gender
Self-Confidence, Autonomy and GenderBy: Pamela Lipsett
Date: May 30, 2012
Several years ago, a general surgery resident researcher, Heather Yeo from Yale, worked with the American Board of Surgery to develop a longitudinal survey of all general surgery residents in the United States about the resident experience. The survey was administered to residents in association with the ABSITE exam to ensure maximal participation. Several publications have informed us about how our residents are experiencing training and what factors seem to influence happiness, successful completion of training, the influence of family and gender on the survey, and finally confidence. Detailed analysis of the data suggested that gender, residency level, program type and marital status are all associated with measures of confidence in residents. In their data, male residents at the PGY V level who were married and from community training programs were confident. Women in the midlevel years, especially when they were from programs in the Northeast, felt less confident.
Does confidence in training result from innate factors such as gender and social norms? Is confidence related primarily to the level of procedural experience? Does enhanced supervision seen in current years when combined with slightly lower numbers of operative cases explain why the number of residents who complete surgery fellowships is increasing?
Molly Carnes, co-founder of the Women in Science and Engineering Leadership Institute, met with our surgical residents and faculty this past year and discussed gender stereotyping. She noted that women residents identified their gender as a negative influence in directing patient care in a medical team. Female residents identified the need to be “less assertive” than their male colleagues and to use a nicer “tone”.
Why would I address these issues in this forum? Our incoming interns are coming to us in a unique time. They have restricted duty hours and scheduled shifts, more required supervision and less autonomy. They will be exposed to all the same elements of training of past years, perioperative care of complex critically ill and injured patients, and they will be performing their first procedures. In so many ways, they will be just like the hundreds of surgical residents who have gone before them.
They are also just a little bit different. Five of the six categorical residents happen to be women. We must ensure that what is known about stereotyping, gender gaps and confidence of women in Northeast academic surgery programs doesn’t happen to our Halsted residents. I have absolute confidence that all of our residents will continue to be great surgeons, researchers, scholars, leaders, and mothers, fathers and partners. We simply need to tell each of them how well they are doing even though the world they are training in is completely different than our own.