Sex Isn’t Everything: The Role of Gender in Early Performance of a Fundamental Laparoscopic Skill

INTRODUCTION: Existing literature on the acquisition of laparoscopic skills suggests that gender affects initial performance, with women generally performing more poorly than men. This literature is limited by looking at an arbitrary number of initial attempts and not adjusting for other factors that may impact surgical performance. The objective of this study was to evaluate the impact of gender on the learning curve for a fundamental laparoscopic task.

METHODS AND PROCEDURES: In a prospective cohort study, 32 laparoscopic simulator naive medical students performed the Fundamentals of Laparoscopic Surgery (FLS) peg transfer task 15 times. For each subject, the scores were plotted to generate a learning curve. The exponential function was fit to these curves using nonlinear regression to estimate learning plateau (asymptote) and learning rate (number of trials to achieve 95% of learning plateau). Variables that may affect early performance, including gender, interest in a surgical career, video game experience, and hand dominance were assessed using a questionnaire. Innate visual-spatial abilities were evaluated using the Card Rotation (CR) and Cube Comparison (CC) tests for spatial orientation, the Map Planning (MP) test for spatial scanning aptitude, and the Pictorial Surface Orientation (PicSOr) test for perceptual abilities. Score on first peg transfer attempt, learning plateau and rate were compared for male and female subjects using Student’s t-test. Innate abilities were correlated to simulator performance using Pearson coefficient. Multivariate linear regression was used to investigate the effect of gender on early laparoscopic performance after adjusting for significant univariate analysis factors. Data are presented as mean (SD). Statistical significance is defined as p<0.05.

RESULTS: 19 males and 13 females participated, of whom 30 (94%) were right handed, 12 (38%) reported high interest in surgery and 26 (80%) had video game experience. There were no differences between men and women in initial peg transfer score (66.5(11.9) vs. 66.8(18.8), p=0.91), learning plateau (97.1(4.1) vs. 97.8(7.9), p=0.74) or learning rate (4.6(2.1) vs. 5.3(3.9) trials, p=0.56). Video game experience did not significantly affect the learning curve. Initial peg transfer score and learning rate were higher in subjects reporting high interest in a surgical career (p=0.02, p=0.03). Initial score also correlated with PicSOr score (p=0.03). In multivariate analysis, gender remained an insignificant predictor of initial peg transfer score (p=0.64), learning plateau (p=0.85) and rate (p=0.32) after adjusting for significant factors on univariate analysis. Only surgical interest remained a significant predictor of score on first peg transfer (p=0.03) and learning rate (p=0.02).

CONCLUSION: Gender does not affect the learning curve for a fundamental laparoscopic skill. In contrast, interest in surgery and visual-spatial and perceptual abilities did influence early performance.

Session: Podium Presentation

Program Number: S035