Resident Operative Autonomy in Robotic Surgery Training: Unpacking Gender Disparities and Training Trends

Abstract

OBJECTIVE: This study evaluated resident and program-level factors associated with resident-reported robotic operative autonomy at our institution. DESIGN: This retrospective cohort study evaluates self-reported residents' robotic case logs detailing case type, console time, and portions of the case completed. The analysis included three procedures: pancreaticoduodenectomies, hernia repairs, and low anterior resection. Each procedure was divided into four key portions. Outcomes measured included minutes at the console and High Resident Autonomy (HRA), defined as >50% resident case participation. Independent variables included graduation cohort, pursued fellowship type, attending gender, underrepresented minority status, and hospital type. Univariable and multivariable logistic regression were performed. SETTING: This study took place at the University of Texas Southwestern Medical Center General Surgery Residency between 2021 and 2023. PARTICIPANTS: Twenty-nine chief residents (postgraduate year 5). RESULTS: Of the 541 cases, 61% were hernia repairs, 26% were low anterior resections, and 13% were pancreaticoduodenectomies. Female residents were present in 60% of the cases. Male residents reported more HRA (76% vs. 54%) and longer console times (150 vs 120 minutes; p < 0.01). Multivariable analysis indicated female gender was associated with 74% lower odds of HRA (95% CI: 0.15 - 0.45; p < 0.001) and 18 fewer minutes of console time versus males (p < 0.01). The 2023 cohort had significantly higher odds of HRA than the 2021 cohort (OR: 4.46, 95% CI: 2.34 - 8.51; p < 0.001) and 15 more console minutes. Residents with aligned fellowships spent 37 more console minutes than those without (p < 0.001). No significant differences were found between attending gender, hospital, and minority status. CONCLUSIONS: Our findings reveal significant gender disparities in self-reported operative autonomy and console time. The recent cohort showed improved training outcomes, and fellowship alignment with the case positively impacted console time. This suggests a need to refine training approaches, ensuring equity and optimizing training efficacy.