Evaluating Differences in Case Volume During Orthopedic Surgery Residency by Gender and Race: A Single-Institution Study

Abstract

Background:

Gaining operative proficiency requires adequate case volume during orthopedic residency training. Numerous surgical fields have demonstrated that male residents report higher case volume than female residents. In general surgery, racially/ethnically underrepresented in medicine residents report lower case volume than White residents.

Purpose:

We sought to evaluate differences in case volume between male and female orthopedic surgery residents and between White residents and those of other races and ethnicities at a single orthopedic residency.

Methods:

Accreditation Council for Graduate Medical Education case logs were reviewed for orthopedic residents from 2010 to 2023 at a single institution. Overall residency case volume and volume by post-graduate year (PGY) were compared between men and women and between White and “other race” residents.

Results:

Of 111 residents included, 80.2% self-reported as men, 19.8% as women, 61.3% as White, non-Hispanic, and 32.4% as any other race (for 6.3%, race/ethnicity was unavailable). Overall, women logged a mean of 1865.6 cases while men logged a mean of 1861.0 cases, showing no difference based on gender. At the PGY-4 level, women logged more cases than men, with a mean of 430.3 for women versus 370.0 for men. There was no difference in overall case volume between White residents and those of “other” race/ethnicity, nor were there race/ethnicity-based differences by PGY level.

Conclusion:

In contrast to prior studies, our retrospective single-institution review found no difference in overall case volume for orthopedic residents based on their self-reported gender or race/ethnicity. Institutions and the specialty at large should continue to create equitable surgical opportunities for orthopedic trainees, while future research should assess autonomy within cases.

Plain Language Summary

How Does Surgical Volume Vary During Orthopedic Surgery Residency by Gender and Race?: Why was the study done? It is imperative that trainees in surgical residencies complete enough surgeries in order to graduate with an adequate skill-set. In many surgical and procedural fields, including general surgery, otolaryngology, ophthalmology, and gastroenterology, trainees who are men have reported higher surgical volumes than women. There are also race-based differences in residency surgical volume. In general surgery, racially and ethnically underrepresented residents have reported lower volumes than their White counterparts. Orthopedic surgery has long had low numbers of women and those who are underrepresented minorities in medicine. The goal of this study was to determine whether such disparities exist in orthopedic surgery residency, specifically looking at differences in surgical volume based on gender and race/ethnicity, at an institution which has made deliberate efforts to promote diversity and reduce disparities. What did the researchers do? We compared surgical volume between orthopedic residents who identify as men versus women, and between White residents and those of other race/ethnicities. We looked at surgical volume both overall throughout residency, and by year of training. What did the researchers find? We found that there was no difference in overall surgical volume between men and women residents. However, women in their fourth year of training (out of 5) completed more surgeries than men. There was no difference in either overall or year-by-year surgical volume based on race. What do the findings mean? These are promising findings demonstrating a lack of gender or race-based disparity in orthopedic residency surgical volume at an institution which has made deliberate efforts to promote diversity. These efforts include hiring diverse faculty, creating organizational structures dedicate toward diversity, equity, and inclusion, and facilitating training on implicit bias.

Level of Evidence: Level IV: retrospective database study.