Gender Differences in Case Volume among Ophthalmology Residents

Dan Gong; Bryan J. Winn; Casey J. Beal; Preston H. Blomquist; Royce W. Chen; Susan M. Culican; Lora R. Dagi Glass; Gary F. Domeracki; Jeffrey M. Goshe; Jeremy K. Jones; Albert S. Khouri; Gary L. Legault; Timothy J. Martin; Kelly T. Mitchell; Ayman Naseri; Thomas A. Oetting; Joshua H. Olson; Jeff H. Pettey; Maria A. Reinoso; Andrew L. Reynolds; R. Michael Siatkowski; Jeffrey R. Soohoo; Grace Sun; Misha F. Syed; Jeremiah P. Tao; Parisa Taravati; Darrell Wudunn; Lama A. Al-Aswad

doi:10.1001/jamaophthalmol.2019.2427

Gender Differences in Case Volume among Ophthalmology Residents

Dan Gong, Bryan J. Winn, Casey J. Beal, Preston H. Blomquist, Royce W. Chen, Susan M. Culican, Lora R. Dagi Glass, Gary F. Domeracki, Jeffrey M. Goshe, Jeremy K. Jones, Albert S. Khouri, Gary L. Legault, Timothy J. Martin, Kelly T. Mitchell, Ayman Naseri, Thomas A. Oetting, Joshua H. Olson, Jeff H. Pettey, Maria A. Reinoso, Andrew L. ReynoldsR. Michael Siatkowski, Jeffrey R. Soohoo, Grace Sun, Misha F. Syed, Jeremiah P. Tao, Parisa Taravati, Darrell Wudunn, Lama A. Al-Aswad

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Abstract

Importance: Although almost equal numbers of male and female medical students enter into ophthalmology residency programs, whether they have similar surgical experiences during training is unclear. Objective: To determine differences for cataract surgery and total procedural volume between male and female residents during ophthalmology residency. Design, Setting, Participants: This retrospective, longitudinal analysis of resident case logs from 24 US ophthalmology residency programs spanned July 2005 to June 2017. A total of 1271 residents were included. Data were analyzed from August 12, 2017, through April 4, 2018. Main Outcomes and Measures: Variables analyzed included mean volumes of cataract surgery and total procedures, resident gender, and maternity or paternity leave status. Results: Among the 1271 residents included in the analysis (815 men [64.1%]), being female was associated with performing fewer cataract operations and total procedures. Male residents performed a mean (SD) of 176.7 (66.2) cataract operations, and female residents performed a mean (SD) of 161.7 (56.2) (mean difference, -15.0 [95% CI, -22.2 to -7.8]; P <.001); men performed a mean (SD) of 509.4 (208.6) total procedures and women performed a mean (SD) of 451.3 (158.8) (mean difference, -58.1 [95% CI, -80.2 to -36.0]; P <.001). Eighty-five of 815 male residents (10.4%) and 71 of 456 female residents (15.6%) took parental leave. Male residents who took paternity leave performed a mean of 27.5 (95% CI, 13.3 to 41.6; P <.001) more cataract operations compared with men who did not take leave, but female residents who took maternity leave performed similar numbers of operations as women who did not take leave (mean difference, -2.0 [95% CI, -18.0 to 14.0]; P =.81). From 2005 to 2017, each additional year was associated with a 5.5 (95% CI, 4.4 to 6.7; P <.001) increase in cataract volume and 24.4 (95% CI, 20.9 to 27.8; P <.001) increase in total procedural volume. This increase was not different between genders for cataract procedure volume (β = -1.6 [95% CI, -3.7 to 0.4]; P =.11) but was different for total procedural volume such that the increase in total procedural volume over time for men was greater than that for women (β = -8.0 [95% CI, -14.0 to -2.1]; P =.008). Conclusions and Relevance: Female residents performed 7.8 to 22.2 fewer cataract operations and 36.0 to 80.2 fewer total procedures compared with their male counterparts from 2005 to 2017, a finding that warrants further exploration to ensure that residents have equivalent surgical training experiences during residency regardless of gender. However, this study included a limited number of programs (24 of 119 [20.2%]). Future research including all ophthalmology residency programs may minimize the selection bias issues present in this study..

Original language	English (US)
Pages (from-to)	1015-1020
Number of pages	6
Journal	JAMA Ophthalmology
Volume	137
Issue number	9
DOIs	https://doi.org/10.1001/jamaophthalmol.2019.2427
State	Published - Sep 2019

Bibliographical note

Funding Information:
to the Department of Ophthalmology and Visual Sciences at Washington University; and Vision Core Grant P30 EY 0268 from the National Institutes of Health.

Funding Information:
part by an unrestricted grant from Research to Prevent Blindness, Inc (Drs Gong, Winn, Chen, Dagi Glass, and Al-Aswad), to the Columbia University Medical Center Department of Ophthalmology; an unrestricted grant from Research to Prevent Blindness, Inc (Dr Culican),

Funding Information:
receiving personal fees from Carl Zeiss Meditec, Allergan, and Alimera Sciences, Inc, outside the submitted work. Dr Dagi Glass reported receiving an unrestricted departmental grant to Columbia Ophthalmology from Research to Prevent Blindness during the conduct of the study. Dr Khouri reported receiving grants from Allergan and NJ Health Foundation outside the submitted work. Dr Taravati reported receiving grants from Research to Prevent Blindness during the conduct of the study. Dr Al-Aswad reported serving as the President of Women in Ophthalmology in 2018. No other disclosures were reported.

Publisher Copyright:
© 2019 American Medical Association. All rights reserved.

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Gong, D., Winn, B. J., Beal, C. J., Blomquist, P. H., Chen, R. W., Culican, S. M., Dagi Glass, L. R., Domeracki, G. F., Goshe, J. M., Jones, J. K., Khouri, A. S., Legault, G. L., Martin, T. J., Mitchell, K. T., Naseri, A., Oetting, T. A., Olson, J. H., Pettey, J. H., Reinoso, M. A., ... Al-Aswad, L. A. (2019). Gender Differences in Case Volume among Ophthalmology Residents. JAMA Ophthalmology, 137(9), 1015-1020. https://doi.org/10.1001/jamaophthalmol.2019.2427

Gong, D, Winn, BJ, Beal, CJ, Blomquist, PH, Chen, RW, Culican, SM, Dagi Glass, LR, Domeracki, GF, Goshe, JM, Jones, JK, Khouri, AS, Legault, GL, Martin, TJ, Mitchell, KT, Naseri, A, Oetting, TA, Olson, JH, Pettey, JH, Reinoso, MA, Reynolds, AL, Siatkowski, RM, Soohoo, JR, Sun, G, Syed, MF, Tao, JP, Taravati, P, Wudunn, D & Al-Aswad, LA 2019, 'Gender Differences in Case Volume among Ophthalmology Residents', JAMA Ophthalmology, vol. 137, no. 9, pp. 1015-1020. https://doi.org/10.1001/jamaophthalmol.2019.2427

@article{6c155a35edaf40e2ae6d96eaa918b7d9,

title = "Gender Differences in Case Volume among Ophthalmology Residents",

abstract = "Importance: Although almost equal numbers of male and female medical students enter into ophthalmology residency programs, whether they have similar surgical experiences during training is unclear. Objective: To determine differences for cataract surgery and total procedural volume between male and female residents during ophthalmology residency. Design, Setting, Participants: This retrospective, longitudinal analysis of resident case logs from 24 US ophthalmology residency programs spanned July 2005 to June 2017. A total of 1271 residents were included. Data were analyzed from August 12, 2017, through April 4, 2018. Main Outcomes and Measures: Variables analyzed included mean volumes of cataract surgery and total procedures, resident gender, and maternity or paternity leave status. Results: Among the 1271 residents included in the analysis (815 men [64.1%]), being female was associated with performing fewer cataract operations and total procedures. Male residents performed a mean (SD) of 176.7 (66.2) cataract operations, and female residents performed a mean (SD) of 161.7 (56.2) (mean difference, -15.0 [95% CI, -22.2 to -7.8]; P <.001); men performed a mean (SD) of 509.4 (208.6) total procedures and women performed a mean (SD) of 451.3 (158.8) (mean difference, -58.1 [95% CI, -80.2 to -36.0]; P <.001). Eighty-five of 815 male residents (10.4%) and 71 of 456 female residents (15.6%) took parental leave. Male residents who took paternity leave performed a mean of 27.5 (95% CI, 13.3 to 41.6; P <.001) more cataract operations compared with men who did not take leave, but female residents who took maternity leave performed similar numbers of operations as women who did not take leave (mean difference, -2.0 [95% CI, -18.0 to 14.0]; P =.81). From 2005 to 2017, each additional year was associated with a 5.5 (95% CI, 4.4 to 6.7; P <.001) increase in cataract volume and 24.4 (95% CI, 20.9 to 27.8; P <.001) increase in total procedural volume. This increase was not different between genders for cataract procedure volume (β = -1.6 [95% CI, -3.7 to 0.4]; P =.11) but was different for total procedural volume such that the increase in total procedural volume over time for men was greater than that for women (β = -8.0 [95% CI, -14.0 to -2.1]; P =.008). Conclusions and Relevance: Female residents performed 7.8 to 22.2 fewer cataract operations and 36.0 to 80.2 fewer total procedures compared with their male counterparts from 2005 to 2017, a finding that warrants further exploration to ensure that residents have equivalent surgical training experiences during residency regardless of gender. However, this study included a limited number of programs (24 of 119 [20.2%]). Future research including all ophthalmology residency programs may minimize the selection bias issues present in this study..",

author = "Dan Gong and Winn, {Bryan J.} and Beal, {Casey J.} and Blomquist, {Preston H.} and Chen, {Royce W.} and Culican, {Susan M.} and {Dagi Glass}, {Lora R.} and Domeracki, {Gary F.} and Goshe, {Jeffrey M.} and Jones, {Jeremy K.} and Khouri, {Albert S.} and Legault, {Gary L.} and Martin, {Timothy J.} and Mitchell, {Kelly T.} and Ayman Naseri and Oetting, {Thomas A.} and Olson, {Joshua H.} and Pettey, {Jeff H.} and Reinoso, {Maria A.} and Reynolds, {Andrew L.} and Siatkowski, {R. Michael} and Soohoo, {Jeffrey R.} and Grace Sun and Syed, {Misha F.} and Tao, {Jeremiah P.} and Parisa Taravati and Darrell Wudunn and Al-Aswad, {Lama A.}",

note = "Funding Information: to the Department of Ophthalmology and Visual Sciences at Washington University; and Vision Core Grant P30 EY 0268 from the National Institutes of Health. Funding Information: part by an unrestricted grant from Research to Prevent Blindness, Inc (Drs Gong, Winn, Chen, Dagi Glass, and Al-Aswad), to the Columbia University Medical Center Department of Ophthalmology; an unrestricted grant from Research to Prevent Blindness, Inc (Dr Culican), Funding Information: receiving personal fees from Carl Zeiss Meditec, Allergan, and Alimera Sciences, Inc, outside the submitted work. Dr Dagi Glass reported receiving an unrestricted departmental grant to Columbia Ophthalmology from Research to Prevent Blindness during the conduct of the study. Dr Khouri reported receiving grants from Allergan and NJ Health Foundation outside the submitted work. Dr Taravati reported receiving grants from Research to Prevent Blindness during the conduct of the study. Dr Al-Aswad reported serving as the President of Women in Ophthalmology in 2018. No other disclosures were reported. Publisher Copyright: {\textcopyright} 2019 American Medical Association. All rights reserved.",

year = "2019",

month = sep,

doi = "10.1001/jamaophthalmol.2019.2427",

language = "English (US)",

volume = "137",

pages = "1015--1020",

journal = "JAMA Ophthalmology",

issn = "2168-6165",

publisher = "American Medical Association",

number = "9",

}

TY - JOUR

T1 - Gender Differences in Case Volume among Ophthalmology Residents

AU - Gong, Dan

AU - Winn, Bryan J.

AU - Beal, Casey J.

AU - Blomquist, Preston H.

AU - Chen, Royce W.

AU - Culican, Susan M.

AU - Dagi Glass, Lora R.

AU - Domeracki, Gary F.

AU - Goshe, Jeffrey M.

AU - Jones, Jeremy K.

AU - Khouri, Albert S.

AU - Legault, Gary L.

AU - Martin, Timothy J.

AU - Mitchell, Kelly T.

AU - Naseri, Ayman

AU - Oetting, Thomas A.

AU - Olson, Joshua H.

AU - Pettey, Jeff H.

AU - Reinoso, Maria A.

AU - Reynolds, Andrew L.

AU - Siatkowski, R. Michael

AU - Soohoo, Jeffrey R.

AU - Sun, Grace

AU - Syed, Misha F.

AU - Tao, Jeremiah P.

AU - Taravati, Parisa

AU - Wudunn, Darrell

AU - Al-Aswad, Lama A.

N1 - Funding Information: to the Department of Ophthalmology and Visual Sciences at Washington University; and Vision Core Grant P30 EY 0268 from the National Institutes of Health. Funding Information: part by an unrestricted grant from Research to Prevent Blindness, Inc (Drs Gong, Winn, Chen, Dagi Glass, and Al-Aswad), to the Columbia University Medical Center Department of Ophthalmology; an unrestricted grant from Research to Prevent Blindness, Inc (Dr Culican), Funding Information: receiving personal fees from Carl Zeiss Meditec, Allergan, and Alimera Sciences, Inc, outside the submitted work. Dr Dagi Glass reported receiving an unrestricted departmental grant to Columbia Ophthalmology from Research to Prevent Blindness during the conduct of the study. Dr Khouri reported receiving grants from Allergan and NJ Health Foundation outside the submitted work. Dr Taravati reported receiving grants from Research to Prevent Blindness during the conduct of the study. Dr Al-Aswad reported serving as the President of Women in Ophthalmology in 2018. No other disclosures were reported. Publisher Copyright: © 2019 American Medical Association. All rights reserved.

PY - 2019/9

Y1 - 2019/9

N2 - Importance: Although almost equal numbers of male and female medical students enter into ophthalmology residency programs, whether they have similar surgical experiences during training is unclear. Objective: To determine differences for cataract surgery and total procedural volume between male and female residents during ophthalmology residency. Design, Setting, Participants: This retrospective, longitudinal analysis of resident case logs from 24 US ophthalmology residency programs spanned July 2005 to June 2017. A total of 1271 residents were included. Data were analyzed from August 12, 2017, through April 4, 2018. Main Outcomes and Measures: Variables analyzed included mean volumes of cataract surgery and total procedures, resident gender, and maternity or paternity leave status. Results: Among the 1271 residents included in the analysis (815 men [64.1%]), being female was associated with performing fewer cataract operations and total procedures. Male residents performed a mean (SD) of 176.7 (66.2) cataract operations, and female residents performed a mean (SD) of 161.7 (56.2) (mean difference, -15.0 [95% CI, -22.2 to -7.8]; P <.001); men performed a mean (SD) of 509.4 (208.6) total procedures and women performed a mean (SD) of 451.3 (158.8) (mean difference, -58.1 [95% CI, -80.2 to -36.0]; P <.001). Eighty-five of 815 male residents (10.4%) and 71 of 456 female residents (15.6%) took parental leave. Male residents who took paternity leave performed a mean of 27.5 (95% CI, 13.3 to 41.6; P <.001) more cataract operations compared with men who did not take leave, but female residents who took maternity leave performed similar numbers of operations as women who did not take leave (mean difference, -2.0 [95% CI, -18.0 to 14.0]; P =.81). From 2005 to 2017, each additional year was associated with a 5.5 (95% CI, 4.4 to 6.7; P <.001) increase in cataract volume and 24.4 (95% CI, 20.9 to 27.8; P <.001) increase in total procedural volume. This increase was not different between genders for cataract procedure volume (β = -1.6 [95% CI, -3.7 to 0.4]; P =.11) but was different for total procedural volume such that the increase in total procedural volume over time for men was greater than that for women (β = -8.0 [95% CI, -14.0 to -2.1]; P =.008). Conclusions and Relevance: Female residents performed 7.8 to 22.2 fewer cataract operations and 36.0 to 80.2 fewer total procedures compared with their male counterparts from 2005 to 2017, a finding that warrants further exploration to ensure that residents have equivalent surgical training experiences during residency regardless of gender. However, this study included a limited number of programs (24 of 119 [20.2%]). Future research including all ophthalmology residency programs may minimize the selection bias issues present in this study..

AB - Importance: Although almost equal numbers of male and female medical students enter into ophthalmology residency programs, whether they have similar surgical experiences during training is unclear. Objective: To determine differences for cataract surgery and total procedural volume between male and female residents during ophthalmology residency. Design, Setting, Participants: This retrospective, longitudinal analysis of resident case logs from 24 US ophthalmology residency programs spanned July 2005 to June 2017. A total of 1271 residents were included. Data were analyzed from August 12, 2017, through April 4, 2018. Main Outcomes and Measures: Variables analyzed included mean volumes of cataract surgery and total procedures, resident gender, and maternity or paternity leave status. Results: Among the 1271 residents included in the analysis (815 men [64.1%]), being female was associated with performing fewer cataract operations and total procedures. Male residents performed a mean (SD) of 176.7 (66.2) cataract operations, and female residents performed a mean (SD) of 161.7 (56.2) (mean difference, -15.0 [95% CI, -22.2 to -7.8]; P <.001); men performed a mean (SD) of 509.4 (208.6) total procedures and women performed a mean (SD) of 451.3 (158.8) (mean difference, -58.1 [95% CI, -80.2 to -36.0]; P <.001). Eighty-five of 815 male residents (10.4%) and 71 of 456 female residents (15.6%) took parental leave. Male residents who took paternity leave performed a mean of 27.5 (95% CI, 13.3 to 41.6; P <.001) more cataract operations compared with men who did not take leave, but female residents who took maternity leave performed similar numbers of operations as women who did not take leave (mean difference, -2.0 [95% CI, -18.0 to 14.0]; P =.81). From 2005 to 2017, each additional year was associated with a 5.5 (95% CI, 4.4 to 6.7; P <.001) increase in cataract volume and 24.4 (95% CI, 20.9 to 27.8; P <.001) increase in total procedural volume. This increase was not different between genders for cataract procedure volume (β = -1.6 [95% CI, -3.7 to 0.4]; P =.11) but was different for total procedural volume such that the increase in total procedural volume over time for men was greater than that for women (β = -8.0 [95% CI, -14.0 to -2.1]; P =.008). Conclusions and Relevance: Female residents performed 7.8 to 22.2 fewer cataract operations and 36.0 to 80.2 fewer total procedures compared with their male counterparts from 2005 to 2017, a finding that warrants further exploration to ensure that residents have equivalent surgical training experiences during residency regardless of gender. However, this study included a limited number of programs (24 of 119 [20.2%]). Future research including all ophthalmology residency programs may minimize the selection bias issues present in this study..

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Gender Differences in Case Volume among Ophthalmology Residents

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