Resident perspectives on the role of gender in operative experience during general surgery residency training: A mixed-methods study

Background: It remains unclear why female general surgery residents perform fewer cases than male peers. This exploratory study investigated possible contributors to gender-based disparities and solutions for improving equity in operative experience. Methods: Surveys, including Likert scale and free-text questions, were distributed to 21 accredited general surgery residency programs. Results: There were 96 respondents, of whom 69% were female. 22% of females personally experienced barriers to operative experience versus 13% of males (p = 0.41), while 52% of female residents believed operative training was affected by gender (p = 0.004). Inductive analysis revealed the most common barrier to operating room participation was floor work/clinical tasks. The most common barrier for female residents was perceived sexism/ gender bias, with subthemes of "misidentification," "feeling unwelcome," and "poor trust/autonomy." To improve parity, residents proposed structured program-level review, feedback, and transparent expectations about case assignments. Conclusion: Female general surgery residents believe gender bias impacts training. Further mixed-methods research is crucial to determine the cause of gender-based disparities in operative experience.