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Trends in Operative Case Logs of Chief Residents in Surgery by Gender and Race: A 5-Year National Study
*Polina Zmijewski¹, *Yoon Soo Park², *Eric Holmboe², Mary Klingensmith², *Alexander Cortez³, *Brenessa Lindeman¹, *Brigitte Smith⁴, Herbert Chen¹, *Jessica Fazendin^1
1University of Alabama at Birmingham, Birmingham, AL; ²Accreditation Council for Graduate Medical Education, Chicago, IL; ³University of California, San Francisco, San Francisco, CA; ⁴University of Utah Health, Salt Lake City, UT

Objectives: A recent study of 21 institutions noted significant differences between number of cases reported during general surgery residency by residents who are Underrepresented in Medicine (URiM) versus trainees who are not Underrepresented in Medicine (non-URiM). This study also identified differences between residents who identify as female versus residents who identify as male. We partnered with the Accreditation Council for Graduate Medical Education to examine case logs reported from to all accredited general surgery programs in the United States. This is the first time this data has been examined nationally. Methods: URiM versus non-URiM residents were categorized based on the definition upheld by the Association of American Medical Colleges. We examined total case logs submitted by graduating residents between 2017 and 2022. Group differences in mean reported case logs were examined using t- tests for female versus male and URiM versus non- URiM overall case numbers. Results: A total of 6,458 residents submitted case logs from 319 accredited programs. Eight-hundred and fifty-four (13%) were URiM and 5,604 (87%) were non-URiM. Over the 5-year study period, URM residents submitted 1096.95 (SD +/- 160.57) major cases vs. 1115.96 (+/- 160.53) for non-URiM residents (difference =19 cases, p= 0.001). Case logs were submitted by 3,833 (60.1%) male residents and 2,625 (39.9%) female residents over the five-year study period. Male residents reported 1128.56 (SD +/- 168.32) cases vs. 1091.38 (+/- 145.98) cases reported by females (difference = 37.18, p< 0.001). When looking at Surgeon Chief and Teaching Assistant cases, there was no significant difference noted between cases submitted by URiM vs. non- URiM residents. However, male residents reported significantly more in both categories than their female peers (p<0.001). Conclusions: Overall, URiM residents submitted fewer cases in the five- year study period than their non-URiM peers. The gap in submitted cases between male and female residents was more pronounced, with male residents submitting significantly more cases than their female counterparts. This finding was consistent and statistically significant throughout the entire study period, in all case categories, and without narrowing of difference over time. A difference of 30-40 cases can amount to 1-3 months of surgical training and is a concerning national trend deserving the attention of every training program and our governing institutions.

Trends in Operative Case Logs of Chief Residents in Surgery by Gender and Race: A 5 – Year National Study

	Non-URiM versus URiM Case # Difference	URiM More or Less Cases	P value	Male versus Female	Female More or Less Cases	P value
2017 -2018	37.32	Less	0.011	25.86	Less	0.004
2018-2019	16.40	Less	0.198	35.71	Less	<0.001
2019-2020	12.23	Less	0.344	43.08	Less	<0.001
2020- 2021	23.73	Less	0.075	34.70	Less	<0.001
2021-2022	5.72	Less	0.646	44.95	Less	<0.001

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