Impact of Trainee Age and Sex on Operative Training Experience

• Female trainees in General Surgery performed 7% fewer index procedures and 2% fewer total procedures per month compared to male peers. • Older trainees (over 30 on starting ST3) in general Surgery completed 1% more index procedures and 3% more procedures overall compared to younger trainees. • Female trainees in General Surgery recorded 19% fewer procedures as "performed" and 24% fewer as “Training a Trainee” in comparison to male trainees. Differential attainment has previously been demonstrated in Annual Review of Competence Progression (ARCP) outcomes of General Surgery Specialty Registrars (STRs). We aim to investigate whether differences by trainee characteristic can be observed in trainee operative recording and operative independence. Data from the intercollegiate surgical curriculum program (ISCP) and eLogbook were analyzed between January 2018 and December 2023. Trainee monthly and annual total operation, total index procedure, and supervision level counts were modelled using a multivariate negative binomial regression model, adjusting for other available trainee demographics, deanery, and working patterns. All results are presented as incident risk ratios (IRR) based on number of procedures performed in each category per calendar month. Data from 1,231,187 operations recorded by 1689 trainees were analyzed. Female trainees in General Surgery recorded 7% fewer index procedures, and 2% fewer total procedures per month, significantly fewer than their male peers (IRR 0.93, 95% Confidence Interval 95% CI 0.97-0.99; and IRR 0.98, 95% CI 0.92-0.94 respectively). Older trainees (over 30 on starting StR) recorded 1% more index procedures and 3% more procedures overall compared to younger trainees (IRR 1.02, 95% CI 0.99-1.02; and IRR 1.03, 95% CI 1.02-1.04 respectively). Female trainees recorded 19% fewer procedures as “performed,” and 24% fewer as “Training a Trainee.” Female trainees record fewer operations per month than their male counterparts and are less likely to document themselves as performing procedures independently or supervising junior trainees. This suggests gender-based disparities in operative experience, with potential consequences for the development of procedural independence and surgical competencies. Background: Differential attainment (DA) has been demonstrated in multiple aspects of both undergraduate and postgraduate medical training in the UK. In Surgical training DA has been demonstrated at the Annual Review of Competence Progression (ARCP) and in postgraduate examinations. Differential Attainment perpetuates systemic inequalities and undermines the validity of that training, as well as impeding efforts to develop a safe and competent workforce which reflects the population it serves.