Gender disparities among general surgery residents’ ACGME case logs develop over the course of training

Abstract Background Gender disparities in operative autonomy and case volume persist in general surgery residency training. Compared to their male counterparts, female trainees graduate with lower ACGME case log totals and perceive lower intraoperative autonomy. While prior studies of resident case logs have relied on summary level data from graduating residents, this study utilizes individual case level data to better elucidate when these disparities emerge in training, and how factors such as PGY level and faculty gender might also influence these differences. Methods We conducted a retrospective analysis of 569,761 ACGME case log entries from 473 general surgery residents and 415 attendings at six university-based programs from July 2016 to June 2023. Resident and attending gender were obtained via self-reported SIMPL data. We examined total case volumes and case roles (First Assistant, Surgeon Junior, Surgeon Chief, Teaching Assistant) stratified by resident gender, attending gender, and post-graduate year (PGY). A multilevel logistic regression was performed to understand the association between resident gender, attending gender, and case logging trends. Results Female residents logged 8.1% fewer cases on average (1153 vs 1255, p = 0.04). When cases were stratified by operative role and PGY level, female residents were more likely to log cases as “first assistant” with the disparity widening as PGY level increased: PGY3 OR 1.57, 95% CI [1.14, 2.16]; PGY4 OR 2.76, 95% CI [1.97, 3.88]; and PGY5 OR 3.72, 95% CI [2.42, 5.70]. There were no differences in primary surgeon case logging trends. Overall, cases involving female faculty were less likely to be logged as “first assistant” OR 0.79, 95% CI [0.59, 0.91], however, among senior residents this association was reversed: PGY4 OR 1.68, 95% CI [1.09, 2.59] and PGY5 OR 2.46, 95% CI [1.22, 4.99]. There were no significant differences identified in case logs for residents operating with concordant versus discordant attending gender dyads. Conclusion This study reveals how gender-based differences in case logging behavior and operative roles develop over the course of residency training, with female senior residents logging cases as first assistant significantly more than their male counterparts. Additional research—particularly using EPA-based assessment data and qualitative methods—is needed to determine whether these trends reflect true differences in operative opportunity, or merely differences in perception, or case logging practices. Local program-level monitoring of case log data may offer a pragmatic step toward identifying and addressing disparities in real time.