Reply: Gender Comparison of Medical Student Microsurgical Skills in a Laboratory Model
08 December 2018
21 January 2019
05 March 2019 (online)
We read Sudario-Lumague et al's study assessing gender differences in surgical performance amongst the medical student population. The authors provide evidence of equal performance in microsurgical skills across both genders and the authors should be commended for their promotion of gender equality in the surgical field. Upon further review of the methodology, we have identified some potential confounders that may warrant further clarification to your readership.
First, the authors measured the students' surgical performance at one moment in time. More accurate results may have been yielded had the authors measured performance before and after training, as has been conducted previously. This would allow for a baseline score, highlighting differences in learning new skills across both genders. This would also identify pre-existing surgical skills, the students may have, that could affect the results.
Alternatively, we propose that a questionnaire, prior to training, could identify any pre-existing skill sets the students have. This is a possibility since many students attend courses to develop a passion in surgery, subsequently giving them an unfair advantage when assessing their surgical skills. This data would lend some benefit in assessing performance amongst genders. A questionnaire could also account for nonsurgical skills, such as a history of playing video games or watchmaking that have been shown to influence surgical performance. This element of cross-training is supported by a randomized controlled trial showing that playing video games results in a statistically significant improvement in surgical skills performance.
Second, since this was a single assessment, performance is dependent at one time point. This would enable greater influence of other factors onto performance, such as level of concentration at the time of the examination or effects of physical activity. This is supported by a study that demonstrated higher levels of activity in medical students correlate with reduced accuracy of microsurgical performance. Additionally, music, caffeine, and sleep deprivation have previously been suggested to affect microsurgical performance. Measurement of these factors in the authors' article could help further tease apart the true effect on gender performance on microsurgical skills acquisition. This may be especially pertinent given that other studies have produced conflicting conclusions; one study showed that patients treated by female surgeons were found to have a statistically significant reduction in postoperative complications, in comparison to patients treated by male surgeons.
In conclusion, we appreciate the results of Sudario-Lumague et al's study in eliminating gender differences in microsurgery. However, it is our opinion that further work and clarification is needed to fully evaluate the effects of gender on microsurgical performance by inclusion of other factors that may affect surgical performance.
- 1 Sudario-Lumague R, Chiang YC, Lin TS. Gender comparison of medical student microsurgical skills in a laboratory model. J Reconstr Microsurg 2018; 34 (05) 359-362
- 2 Al Omran Y, Kostusiak M, Myers SR, Ghanem AM. Effects of habitual physical activity on microsurgical performance. Br J Oral Maxillofac Surg 2016; 54 (09) 1025-1027
- 3 Schlickum MK, Hedman L, Enochsson L, Kjellin A, Felländer-Tsai L. Systematic video game training in surgical novices improves performance in virtual reality endoscopic surgical simulators: a prospective randomized study. World J Surg 2009; 33 (11) 2360-2367
- 4 Belykh E, Onaka NR, Abramov IT. , et al. Systematic review of factors influencing surgical performance: practical recommendations for microsurgical procedures in neurosurgery. World Neurosurg 2018; 112: e182-e207
- 5 Wallis CJ, Ravi B, Coburn N, Nam RK, Detsky AS, Satkunasivam R. Comparison of postoperative outcomes among patients treated by male and female surgeons: a population based matched cohort study. BMJ 2017; 359: j4366