Diversity in operative coaching: exploring gender and race differences in evaluations.

backgroundOperative coaching (OC) involves an expert observer rating a resident's case performance to improve surgical competency and practice readiness. To optimize the OC process, we conducted a retrospective study to investigate gender and race differences in OC evaluations.

methodsWe extracted 693 OC evaluations scored by 36 surgeons and 66 PGY2-5 general surgery residents from 7/2017 to 6/2024. Each case was evaluated by the surgeon, coach, and resident with the Surgical Entrustable Professional Activities instrument. Gender was classified as male or female; race as White, Black, or Other.

resultsHalf of residents (48%, n = 32) were female; 57% were White, 17% were Black, and 26% were Other. 25% of attendings were female; 81% were White, 19% were Other. In resident self-evaluations, male residents reported higher scores across measures of operative performance, autonomy, and prospective entrustment (p < 0.05). Faculty (surgeon and coach) scored all residents higher than resident self-assessments, with minimal difference by resident gender. Male faculty evaluating female residents had the highest positive difference in median scores (p < 0.05). Residents in all three racial categories self-evaluated similarly (p > 0.05), but faculty gave the highest scores to White residents and the lowest scores to Black residents in technical skill and prospective entrustment. The median positive difference between faculty and resident scores were the lowest for Other faculty-Black resident pairs.

conclusionGender and race are associated with differences in faculty grading and trainee self-evaluation of operative performance and prospective entrustment in OC cases. Awareness of potential bias should be openly discussed as a component of reflective practice.