Gender differences in operative feedback for vascular surgery trainees

Prior research demonstrates disproportionate emphasis on ‘confidence’ in narrative feedback for women trainees in nonsurgical specialties. Such feedback is often low-quality without corrective guidance. Whether similar feedback is given to women trainees in surgical specialties is unknown. Therefore, we investigated gender differences in agentic word use in operative feedback for vascular surgery trainees. A retrospective review of operative faculty-delivered narrative feedback for a national, multi-institutional cohort of vascular surgery residents and fellows assessed using the Society for Improving Medical Professional Learning (SIMPL) operative application from 2018 to 2023 was performed. Natural language processing models were used to categorize themes using deductive, open coding. Assessments with agentic adjectives were qualitatively analyzed by gender using open and focused coding. We classified feedback as reinforcing (positive), corrective (negative), or neutral, and performed thematic comparisons by gender. Seventeen institutions contributed 1010 intraoperative SIMPL assessments with narrative feedback. Although women had disproportionately more feedback with agentic language, this was more commonly corrective for women (47.8% vs 42% for men). The most common reinforcing theme for trainees of both genders was preparation and planning (34.2% men; 24% women assessments), whereas the most common corrective feedback differed by gender. For men, efficiency was most common (25%), whereas for women, feedback regarding confidence was most common (27.5%). Given confidence reflects a personal characteristic rather than specific, actionable feedback, we explored this thematically. Thirty-two total SIMPL assessments discussed confidence. Over one-half were assessments of women trainees, despite women trainees comprising only 30% of the total cohort. Sixteen comments were corrective, with most (n = 12; 75%) directed toward women trainees, and all were provided by men faculty. Eleven comments were reinforcing, eight of which were for men trainees, and only three for women. When considering the associated autonomy and competency rating accompanying these comments, women tended to receive less positive and more negative feedback about confidence than men at any given level of autonomy and competency. Women vascular trainees receive more agentic-themed operative feedback. Comments regarding lack of confidence are directed at women trainees and are exclusively from men faculty. Given that confidence is an intrinsic trait, rather than an actionable behavior, women trainees receive more low-quality negative feedback, disproportionately limiting their ability to improve operative performance. Attention to quality of faculty feedback is warranted to mitigate gender disparities in training.