Gender Differences in Plastic Surgery Trainee Confidence: A Pilot Analysis During Cleft Lip Simulation.

Background: Underrepresentation of women in plastic surgery remains a concern. This study investigates gender-related differences in self-confidence and surgical ability among plastic surgery trainees in an effort to work toward gender parity.
Methods: Residents and fellows were recorded performing up to three cleft lip repairs on a high-fidelity simulator. Demographic information was collected, and two questionnaires were completed to assess self-confidence after each simulation. Videos were rated blindly using the objective structured assessment of technical skills and unilateral cleft lip repair competency assessment tool. Differences between participants were estimated using generalized estimating equations modeling, and correlation between overall self-confidence and performance was examined using Pearson correlation (r).
Results: Twenty-six participants (six self-identified women and 20 self-identified men) completed 73 simulated procedures. There was no gender-related difference in training level, volume of prior experience, speed with which participants completed each simulated procedure, or objective performance. However, a significant difference was found in overall procedural self-confidence, with women rating their confidence lower (mean = 16.9, SD = 4.3) than men (mean = 19.4, SD = 3.8); P = 0.021. Further analysis revealed that confidence scores correlated more strongly with objective performance for women (r = 0.83) than for men (r = 0.45).
Conclusions: Women plastic surgery trainees overall reported lower self-confidence than their male counterparts, despite demonstrating at least as much skill. Confidence and skill were more closely related for women, suggesting that mentorship focused on concrete skill building may help close the confidence gap.
Competing Interests: The simulator used in this article is proprietary technology developed by Boston Children’s Hospital Immersive Design Systems. Drs. Rogers-Vizena and Saldanha were involved in the development process; the other authors were not involved in the development process and no authors have current financial interest to declare. This work was supported by a National Endowment for Plastic Surgery grant from the Plastic Surgery Foundation.
(Copyright © 2023 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of The American Society of Plastic Surgeons.)