Despite Equal Skills, Female Trainees Express Lower Confidence Than Male Trainees

In a study presented at the 2021 AAOS Annual Meeting, researchers measured and compared the surgical skills of female and male orthopaedic surgery trainees, then analyzed their self-reported confidence levels. Researchers, led by Lauren Elisabeth Wessel, MD, from the Department of Orthopaedic Surgery at the Hospital for Special Surgery, found that, while men and women have equal competency levels, women expressed lower confidence in their skills. The study included residency applicants (158 men and 58 women) who were invited to interview at a single orthopaedic institution from 2017 through 2020. The interview included an assessment of an applicant’s technical and visuomotor skills. Technical skills were assessed by asking a surgeon applicant to reproduce four suture configurations on a pig’s foot. Visuomotor skills were assessed simultaneously, as applicants were required to tap a pedal located under their suture table when specific shapes appeared in their visual field during the suture task. Technical skill was graded on a scale of 1 to 3, and performance on the visual field task was graded as number of correct pedal taps. Applicant’s confidence levels in their manual skills were assessed prior to and after completing the assigned task, on a scale of 1 to 10. Researchers also recorded applicants’ age, sex, race/ethnicity, number of publications at time of application, athletic background (yes/no), and United States Medical Licensing Examination (USMLE) scores. Men and women performed similarly on the skills assessments, with an average surgeon-graded suture task score of 1.7 in both groups. All applicants had 12.2 correct pedal counts. The researchers identified several factors linked to confidence levels: Private medical school education (P=0.04) and higher USMLE Step 1 (P=0.03) scores conferred lower pretest confidence. While self-reported confidence levels were similar before the tasks (6.2 for men and 6.0 for women), the authors reported that post-task self-reported confidence scores were lower among female applicants (4.8 for men and 4.5 women). However, this finding was not statistically significant.