The potential of artificial intelligence as an equalizer of gender disparity in surgical training and education

Abstract

The aim of this work is to offer a panoramic view on how artificial intelligence (AI) can help to break down gender disparity in enrollment and training of women in surgery. Nowadays, many visible and concealed obstacles still exist for women who pursue a surgical career. Impediments due to gender disparity prevent women from choosing surgical specialties. Furthermore, female surgical trainees have to face many difficulties during their training, such as inequity during the residency selection process, sexual harassment, discrimination in pregnancy experience and parental leave, and work-life balance problems. AI has been successfully employed for several applications in surgery to improve patient management, implement the decision-making process, and support training. AI could represent an effective way to overcome barriers related to gender disparity and overcome the obstacles women face during surgical education and training. Virtual and augmented reality, remote mentoring, and simulators could help female surgeons deal with disparities during their training and could positively impact the choice of women when pursuing a surgical career.

Keywords

Women in surgery / artificial intelligence / surgical training / gender discrimination / choose surgery

References

[1] Stephens EH,Temkin SM.The current status of women in surgery: how to affect the future.JAMA Surg2020;155:876-85

[2] Salles A,Goldin L.Estimating implicit and explicit gender bias among health care professionals and surgeons.JAMA Netw Open2019;2:e196545

[3] Ferrari L,Parini S.Discrimination toward women in surgery: a systematic scoping review.Ann Surg2022;276:1-8

[4] Ferrari L,De Santi G.Early barriers to career progression of women in surgery and solutions to improve them: a systematic scoping review.Ann Surg2022;

[5] Larsen AM, Pories S, Parangi S, Robertson FC. Barriers to pursuing a career in surgery: an institutional survey of harvard medical school students.Ann Surg2021;273:1120-6

[6] Trinh LN,Mulcahey MK.Factors influencing female medical students’ decision to pursue surgical specialties: a systematic review.J Surg Educ2021;78:836-49

[7] Are C,O’Holleran B.A multinational perspective on “lifestyle” and other perceptions of contemporary medical students about general surgery.Ann Surg2012;256:378-86

[8] Deedar-Ali-Khawaja R.Trends of surgical career selection among medical students and graduates: a global perspective.J Surg Educ2010;67:237-48

[9] Burgos CM.Gender differences in the learning and teaching of surgery: a literature review.Int J Med Educ2014;5:110-24 PMCID:PMC4207172

[10] Ali A,Ringsted C.Gender differences in the acquisition of surgical skills: a systematic review.Surg Endosc2015;29:3065-73

[11] White MT.Does gender predict performance of novices undergoing Fundamentals of Laparoscopic Surgery (FLS) training?.Am J Surg2012;203:397-400; discussion 400

[12] Babchenko O.Should we train female and male residents slightly differently?.JAMA Surg2020;155:373-4

[13] Kolozsvari NO,Kaneva P.Sex is not everything: the role of gender in early performance of a fundamental laparoscopic skill.Surg Endosc2011;25:1037-42

[14] Hirayama M.Organisational barriers to and facilitators for female surgeons’ career progression: a systematic review.J R Soc Med2018;111:324-34 PMCID:PMC6146338

[15] Zhuge Y,Simeone DM,Velazquez OC.Is there still a glass ceiling for women in academic surgery?.Ann Surg2011;253:637-43

[16] Gumbs AA,Spolverato G.Artificial intelligence surgery: how do we get to autonomous actions in surgery?.Sensors (Basel)2021;21:5526 PMCID:PMC8400539

[17] Fitzgerald JE,Ravindra P.Gender-related perceptions of careers in surgery among new medical graduates: results of a cross-sectional study.Am J Surg2013;206:112-9

[18] Marks IH,Keem M.Barriers to women entering surgical careers: a global study into medical student perceptions.World J Surg2020;44:37-44

[19] Ng CWQ,Hussein RBM,Kow AWC.Push and pull factors, and the role of residents in nurturing medical students’ interest in surgery as a career option in a multicultural Asian context: results of a prospective national cohort study.Am J Surg2020;220:1549-56

[20] Rogers AC,McNamara DA.Gender and specialty influences on personal and professional life among trainees.Ann Surg2019;269:383-7

[21] Altieri MS,Yang J,Pryor AD.What are women being advised by mentors when applying to surgery?.Am Surg2020;86:266-72

[22] Park J,Taylor RA,Poenaru D.Why are women deterred from general surgery training?.Am J Surg2005;190:141-6

[23] Faucett EA,Milinic T,Roward SG.The role of same-sex mentorship and organizational support in encouraging women to pursue surgery.Am J Surg2017;214:640-4

[24] Harris LM,Eidt JF.Altering the career choice: can we attract more women to vascular surgery?.J Vasc Surg2007;45:846-8

[25] Kleinert R,Romotzky V.Generation Y and surgical residency - Passing the baton or the end of the world as we know it?.PLoS One2017;12:e0188114 PMCID:PMC5703530

[26] Walker NR,Glasbey JC.Association of Surgeons in TrainingAttracting medical students and doctors into surgical training in the UK and Ireland.Int J Surg2019;67:107-12

[27] Shin SH,Shalhub S.Integrated residency is associated with an increase in women among vascular surgery trainees.J Vasc Surg2020;71:609-15

[28] Ng CWQ,Hussein RBM,Kow AWC.Factors attracting or deterring female medical students in asia from pursuing a surgical career, and the impact of surgical clerkship, mentorship, and role models: a multicultural asian perspective from a national prospective cohort study.J Surg Res2021;260:200-9

[29] Turrentine FE,St Ivany AR,Schroen AT.Influence of gender on surgical residency applicants’ recommendation letters.J Am Coll Surg2019;228:356-365.e3

[30] Dream S,Tanner L.Do male chairs of surgery have implicit gender bias in the residency application process?.Am J Surg2021;221:697-700

[31] Powers A,Rothman R,Wright RW.Race- and gender-based differences in descriptions of applicants in the letters of recommendation for orthopaedic surgery residency.JB JS Open Access2020;5:e20 PMCID:PMC7386551

[32] Friedman R,Hasbun J.Use of standardized letters of recommendation for otolaryngology head and neck surgery residency and the impact of gender.Laryngoscope2017;127:2738-45

[33] Filippou P,Deal A.The presence of gender bias in letters of recommendations written for urology residency applicants.Urology2019;134:56-61

[34] Lee JS,Kushner H,Peacock ZS.Residency interview experiences in oral and maxillofacial surgery differ by gender and affect residency ranking.J Oral Maxillofac Surg2019;77:2179-95

[35] Harkin E,Liskutin T,Wu K.Discriminatory questions asked during residency programme interviews: perspective from both interviewers and applicants.Postgrad Med J2021;97:355-62

[36] Hern HG Jr,Alter HJ.How prevalent are potentially illegal questions during residency interviews?.Acad Med2016;91:1546-53

[37] Fereydooni A,Morrow KL.Interview experience, post-interview communication, and gender-based differences in the integrated vascular surgery residency match.J Vasc Surg2022;75:316-322.e2

[38] Bohl DD,Kogan M.Inappropriate questions asked of female orthopaedic surgery applicants from 1971 to 2015: a cross-sectional study.J Am Acad Orthop Surg2019;27:519-26

[39] Hoffman A,McCormick M,Matemavi P.Gendered differences in letters of recommendation for transplant surgery fellowship applicants.J Surg Educ2019;76:427-32

[40] Hoffman A,McCormick M,Cusick R.Exploring the gender gap: letters of recommendation to pediatric surgery fellowship.Am J Surg2020;219:932-6

[41] Hoops H,Dewey E,Brasel K.Resident autonomy in the operating room: does gender matter?.Am J Surg2019;217:301-5

[42] Meyerson SL,Zwischenberger JB.Procedural learning and safety collaborativeThe effect of gender on operative autonomy in general surgery residents.Surgery2019;166:738-43 PMCID:PMC7382913

[43] Lane SM,Hayek SA.Meaningful autonomy in general surgery training: exploring for gender bias.Am J Surg2020;219:240-4

[44] Bucholz EM,Yeo H,Bell RH Jr.Our trainees’ confidence: results from a national survey of 4136 US general surgery residents.Arch Surg2011;146:907-14

[45] Gerull KM,Seiler K,Salles A.Assessing gender bias in qualitative evaluations of surgical residents.Am J Surg2019;217:306-13 PMCID:PMC8687875

[46] Minter RM,Napolitano KS.Gender differences in the self-assessment of surgical residents.Am J Surg2005;189:647-50

[47] Cooney CM,Lifchez SD.Differences in operative self-assessment between male and female plastic surgery residents: a survey of 8149 cases.Am J Surg2021;221:799-803

[48] Flyckt RL,Goodman LR,Dutta S.The use of laparoscopy simulation to explore gender differences in resident surgical confidence.Obstet Gynecol Int2017;2017:1945801 PMCID:PMC5288545

[49] Nukala M,Yoo P.Sexual harassment in vascular surgery training programs.Ann Vasc Surg2020;62:92-7

[50] Hu YY,Hewitt DB.Discrimination, abuse, harassment, and burnout in surgical residency training.N Engl J Med2019;381:1741-52 PMCID:PMC6907686

[51] Freedman-Weiss MR,Heller DR.Understanding the barriers to reporting sexual harassment in surgical training.Ann Surg2020;271:608-13

[52] Rangel EL,Castillo-Angeles M.Pregnancy and motherhood during surgical training.JAMA Surg2018;153:644-52 PMCID:PMC5875346

[53] Rangel EL,Haider AH,Doherty GM.Factors associated with residency and career dissatisfaction in childbearing surgical residents.JAMA Surg2018;153:1004-11 PMCID:PMC6583069

[54] Rangel EL,Changala M,Doherty GM.Perspectives of pregnancy and motherhood among general surgery residents: a qualitative analysis.Am J Surg2018;216:754-9

[55] Castillo-Angeles M,Rangel EL.Perspectives of US general surgery program directors on cultural and fiscal barriers to maternity leave and postpartum support during surgical training.JAMA Surg2021;156:647-53 PMCID:PMC8135061

[56] Merchant SJ,Melck AL.Pregnancy among residents enrolled in general surgery: a nationwide survey of attitudes and experiences.Am J Surg2013;206:605-10

[57] Salles A,Cohen GL.Exploring the relationship between stereotype perception and residents’ well-being.J Am Coll Surg2016;222:52-8 PMCID:PMC4862580

[58] Salles A,Cohen G.The relationship between perceived gender judgment and well-being among surgical residents.Am J Surg2018;215:233-7

[59] Dahlke AR,Greenberg CC.Gender differences in utilization of duty-hour regulations, aspects of burnout, and psychological well-being among general surgery residents in the United States.Ann Surg2018;268:204-11

[60] Ellis RJ,Hewitt DB.A comprehensive national survey on thoughts of leaving residency, alternative career paths, and reasons for staying in general surgery training.Am J Surg2020;219:227-32 PMCID:PMC7024040

[61] Liang R,Nestel D.Why do women leave surgical training?.The Lancet2019;393:541-9

[62] Gifford E,Kaji AH.Factors associated with general surgery residents’ desire to leave residency programs: a multi-institutional study.JAMA Surg2014;149:948-53

[63] Ward TM,Madani A,Perretta S.Surgical data science and artificial intelligence for surgical education.J Surg Oncol2021;124:221-30

[64] Nadkarni PM,Chapman WW.Natural language processing: an introduction.J Am Med Inform Assoc2011;18:544-51 PMCID:PMC3168328

[65] Badash I,Solorzano CA.Innovations in surgery simulation: a review of past, current and future techniques.Ann Transl Med2016;4:453 PMCID:PMC5220028

[66] Zevin B,Grantcharov TP.Surgical simulation in 2013: why is it still not the standard in surgical training?.J Am Coll Surg2014;218:294-301

[67] Wilson MS,Sutton C,McCloy RF.MIST VR: a virtual reality trainer for laparoscopic surgery assesses performance.Ann R Coll Surg Engl1997;79:403-4 PMCID:PMC2502952

[68] Ayodeji ID,Jakimowicz J.Face validation of the Simbionix LAP Mentor virtual reality training module and its applicability in the surgical curriculum.Surg Endosc2007;21:1641-9

[69] Elessawy M,Guenther V.Validation of psychomotor tasks by Simbionix LAP Mentor simulator and identifying the target group.Minim Invasive Ther Allied Technol2017;26:262-8

[70] Alaker M,Arulampalam T.Virtual reality training in laparoscopic surgery: a systematic review & meta-analysis.Int J Surg2016;29:85-94

[71] Satava RM.Historical review of surgical simulation - a personal perspective.World J Surg2008;32:141-8

[72] Palter VN.Simulation in surgical education.CMAJ2010;182:1191-6 PMCID:PMC2917931

[73] Liu M.A review of training research and virtual reality simulators for the da Vinci surgical system.Teach Learn Med2015;27:12-26

[74] Lyons C,Jones SL.Which skills really matter?.Surg Endosc2013;27:2020-30

[75] Sarraf D,Imberman B.Use of artificial intelligence for gender bias analysis in letters of recommendation for general surgery residency candidates.Am J Surg2021;222:1051-9

[76] Anvari M,Barlow K.From telementorship to automation.J Surg Oncol2021;124:246-9

[77] Antoniou SA,Franzen J.A comprehensive review of telementoring applications in laparoscopic general surgery.Surg Endosc2012;26:2111-6

[78] Bilgic E,Watanabe Y.Effectiveness of telementoring in surgery compared with on-site mentoring: a systematic review.Surg Innov2017;24:379-85

[79] Byrne JP.Telementoring as an adjunct to training and competence-based assessment in laparoscopic cholecystectomy.Surg Endosc2000;14:1159-61

[80] Bruschi M,Porpiglia F.Laparoscopic telementored adrenalectomy: the Italian experience.Surg Endosc2005;19:836-40

[81] Schlachta CM,Lefebvre KL,Jayaraman S.A model for longitudinal mentoring and telementoring of laparoscopic colon surgery.Surg Endosc2009;23:1634-8

[82] Fuertes-Guiró F,Rodriguez-Franco A.A program of telementoring in laparoscopic bariatric surgery.Minim Invasive Ther Allied Technol2016;25:8-14

[83] Erridge S,Patel HRH.Telementoring of surgeons: a systematic review.Surg Innov2019;26:95-111

[84] Sebajang H,Dougall A,McKinley C.Telementoring: an important enabling tool for the community surgeon.Surg Innov2005;12:327-31

[85] Pears M.The future of immersive technology in global surgery education.Indian J Surg2021;:1-5 PMCID:PMC8248757

[86] Sebajang H,Dougall A,McKinley C.The role of telementoring and telerobotic assistance in the provision of laparoscopic colorectal surgery in rural areas.Surg Endosc2006;20:1389-93

[87] Mendez I,Clarke D,Walling S.Robotic long-distance telementoring in neurosurgery.Neurosurgery2005;56:434-40; discussion 434

[88] Georgi M,Patel S.The impact of same gender speed-mentoring on women’s perceptions of a career in surgery - a prospective cohort study.J Surg Educ2022;

[89] Ip M.Technology not policy will help drive female consultant number higher.Bulletin2020;102:134-7

[90] Maehara T,Fujimaki T.Gender Equality Committee of the Japan Neurosurgical SocietyA questionnaire to assess the challenges faced by women who quit working as full-time neurosurgeons.World Neurosurg2020;133:331-42

[91] Park CW,Kang N.Artificial intelligence in health care: current applications and issues.J Korean Med Sci2020;35:e379 PMCID:PMC7606883

[92] Bruns NE,Rothenberg SS,Kotobi H.Trans-Atlantic telementoring with pediatric surgeons: technical considerations and lessons learned.J Laparoendosc Adv Surg Tech A2016;26:75-8

[93] O’Sullivan S,Allen C.Legal, regulatory, and ethical frameworks for development of standards in artificial intelligence (AI) and autonomous robotic surgery.Int J Med Robot2019;15:e1968

[94] Kono E,Kouchi M.Ergonomic evaluation of a mechanical anastomotic stapler used by Japanese surgeons.Surg Today2014;44:1040-7 PMCID:PMC4019821

[95] Sutton E,Zeigler C,Park A.The ergonomics of women in surgery.Surg Endosc2014;28:1051-5

[96] Shepherd JM,Hamade A.Ergonomics in laparoscopic surgery - a survey of symptoms and contributing factors.Surg Laparosc Endosc Percutan Tech2016;26:72-7