The role of gender in operative autonomy in orthopaedic surgical trainees (GOAST): A national collaborative project.

Aims
Global literature suggests that female surgical trainees have lower rates of independent operating (operative autonomy) than their male counterparts. The objective was to identify any association between gender and lead/independent operating in specialty orthopaedic trainees within the UK national training programme.

Methods
Retrospective case-control study utilising electronic surgical logbook data from 2009-2021 for 274 UK orthopaedic trainees. Total operative numbers and level of supervision were compared between male and female trainees, with correction for less than full time (LTFT), prior experience and time out during training (OOP).

Primary outcome measure
The primary outcome was the percentage of cases undertaken as lead surgeon (supervised and unsupervised) by UK orthopaedic trainees by gender.

Results
All participants gave permission for their data to be used. 274 UK orthopaedic trainees submitted data (65% men 177 and 33% women 91), with a total of 285,915 surgical procedures logged over 1364 trainee-years. Males were lead surgeon (under supervision) on 3% more cases than females (61% 115948/189378 & 58% 50285/86375 respectively, p<0.001), and independent operator on 1% more cases.

A similar trend of higher operative numbers in male trainees was seen for senior (ST6-8) trainees (+5% & +1%, p<0.001), those with no time OOP (+6% & +8%, p<0.001) and those with surgical experience prior to orthopaedic training (+7% & +3% for lead surgeon and independent operator respectively, p<0.001). The gender difference was less marked for those on LTFT training, those who took time OOP and those with no prior orthopaedic experience.

Discussion
This study demonstrated a mean difference of 54 more operative cases being performed by men compared to women during UK orthopaedic training (61% versus 58%, estimated /1800 target cases, p