The Sex Difference in Basic Surgical Skills Learning: A Comparative Study

doi:10.1016/j.jsurg.2016.04.002

Journal of Surgical Education

Volume 73, Issue 5, September–October 2016, Pages 902-905

https://doi.org/10.1016/j.jsurg.2016.04.002 Get rights and content

Background

Very little is known of sex-related differences among medical students in the acquisition of basic surgical skills at an undergraduate level. The aim of this study was to investigate the sex differences in basic surgical skills learning and the possible explanations for sex disparities within basic surgical skills education.

Methods

A didactic description of 10 surgical skills was performed, including knot tying, basic suture I, basic suture II, sterile technique, preoperative preparation, phlebotomy, debridement, laparotomy, cecectomy, and small bowel resection with hand-sewn anastomosis. The students were rated on a 100-point scale for each basic surgical skill. Later during the same semester all the students took the final theoretical examination. Results: A total of 342 (male = 317 and female = 25) medical students participated in a single skills laboratory as part of their third-year medical student clerkship. The mean scores for each of the 10 surgical skills were higher in female group. The difference in sterile technique, preoperative preparation, cecectomy, and small bowel resection with hand-sewn anastomosis reached the significant level. Compared with male medical students, the mean theory examination score was significantly higher in female medical students. Approximately 76% of the (19 of 25) female students expressed their interest in pursuing a surgical career, whereas only 65.5% (207 of 317) male students wanted to be surgical professionals (p = 0.381).

Conclusions

Female medical students completed basic surgical skills training more efficiently and passed the theoretical examination with significantly higher scores than male medical students. In the future, studies should be done in other classes in our institution and perhaps other schools to see if these findings are reliable or valid or just a reflection of this 1 sample.

Section snippets

Background

Women are increasingly participating in the surgical profession,¹ although the profession remains male-dominated, with women representing 10% to 20% of surgeons according to different studies.2, 3 Also, the percentage of female medical students remains below the percentage of male medical students in China. Previous studies reported that females are less attracted than males to surgical specialties, which may be because of differences in the acquisition of skills.⁴ However, very little is known

Methods

This study was approved by the Ethics Committee of the Second Military Medical University. All experimental dogs were treated in accordance with the guidelines of the Ethics Committee of the Second Military Medical University. In this study, the students were senior undergraduates of clinical medicine at the Second Military Medical University. At the beginning of this training, they had finished 2 years of basic medicine and began to study clinical medicine. As an essential course for the

Statistical Analysis

Descriptive statistics (mean and standard deviation) were calculated for each of the 10 surgical skills. t-Tests were used to compare the mean test values for each of the ten surgical procedures and theoretical examination. A value of p < 0.05 was used to determine the level of statistical significance. Analyses were conducted using SPSS version 17.0 (SPSS, Chicago, IL).

Results and Discussion

A total of 342(male = 317 and female = 25) medical students participated in a single skills laboratory as part of their third-year medical student clerkship during the fall of 2014 at the Chang-hai Hospital, shanghai, China. Evaluation data were collected from all students and were used for the statistical analysis. The male and female student skills assessment scores for each skill are listed in the Table. The mean scores for each of the 10 surgical skills are higher in female group. The

Conclusions

Female medical students completed basic surgical skills training more efficiently and passed the theoretical examination with significantly higher scores than male medical students. Sex differences in attitudes toward a surgical career could be the reason for motivation differences that may explain the finding that female medical students had higher scores than males on the surgical skills and the theoretical examination. In the future, studies should be done should be done in other classes in

References (8)

I. Helenius et al.
Surgical procedure skills of graduating medical students: effects of sex, working, and research experience
J Surg Res
(2002)
J.E. Schroeder et al.
Medical students’ and interns’ interest in orthopedic surgery: the gender factor
J Surg Educ
(2014)
R. Quinlan
Gender and the surgical workforce
Arch Surg
(2007)
K. Soreide et al.
Surgery in Norway: beyond the scalpel in the 21st century
Arch Surg
(2008)

There are more references available in the full text version of this article.

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The demographic shift is expected to influence the proportion of male versus female surgeons in the near future; therefore, gender differences in performance become an essential implication for medical education, particularly in training of surgical skills. Several studies have investigated the acquisition of surgical skills by gender, and some of such studies2–6 have reported that men generally performed better than women, whereas some studies have shown that women performed as well as if not better than men.7–10 Nonetheless, some earlier studies have only considered time as a factor in the acquisition of surgical skills without considering other important parameters such as erroneous performance.3,4
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The metric analysis of the VR task “suture sponge” showed that female students required less time (difference: −170.7 seconds, 95% CI: −247.4 to −94.0) and had fewer errors (error difference: −50, 95% CI: −74.2 to −25.8) to complete the suture sponge exercise compared to male students. Moreover, female students completed more stitches than male students (differences in mean stitch achieved: .35; 95% CI: .06 to .65). However, there was no difference in the quality scores of stitches by gender (p = 0.85).
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^☆: Zheng Lou, Zhi-qing Zhao, Wei Zhang, and En-da Yu were involved in performing the education and drafted the manuscript; Fei-hu Yan, Xian-qi Shui, Jia Liu, Dong-lan Zhuo, and Li Li co-ordinated and provided the collection of all the data in addition to providing financial support for this work; Fei-hu Yan, Xian-qi Shui, Jia Liu, Dong-lan Zhuo, Li Li participated in its design and coordination and helped to draft the manuscript. All authors have read and approved the final manuscript.

^☆☆: This work was supported by Medical Students’ Education Reform and Research Fund from the Second Military Medical University (CMC2014011 and CMC2014016), Shanghai, China.

¹: Zheng Lou and Fei-hu Yan contributed equally to this work and were considered co-first authors.

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Original ReportsThe Sex Difference in Basic Surgical Skills Learning: A Comparative Study☆,☆☆

Background

Methods

Conclusions

Section snippets

Background

Methods

Statistical Analysis

Results and Discussion

Conclusions

J Surg Res

J Surg Educ

Gender and the surgical workforce

Arch Surg

Surgery in Norway: beyond the scalpel in the 21st century

Arch Surg

Original Reports
The Sex Difference in Basic Surgical Skills Learning: A Comparative Study☆,☆☆