title: Differences in final product of a bowel anastomosis of male and female novice surgeons.
abstract: BACKGROUND
  There is a disproportionate ratio of male to female surgeons when compared with the ratio at medical school. Although gender differences in surgical technical ability is not known, studies have shown gender differences in visuospatial ability and manual dexterity. We devised a study to assess objectively the quality of final product of small bowel anastomosis in male and female novice surgeons to explore differences in surgical technical ability.
  
  
  METHODS
  Thirty-six novice surgeons in the final year of medical school with minimal surgical experience were taught surgical knot tying and small bowel suturing. The students were asked to complete 7 small bowel anastomosis in 7 separate sessions. The quality of the final product was assessed looking at the "fine details" (number of sutures and accuracy, ie, ratio of sutures piercing the full thickness of the bowel) and the "gross apposition" of the bowel ends at the anastomotic site. A grading system for apposition was devised to assess apposition.
  
  
  RESULTS
  The results with fine details and accuracy of suturing revealed that female surgeons were significantly better in the fourth to the sixth sessions with no gender difference in the number of sutures placed. With gross apposition at the anastomotic ends, male surgeons were consistently better between the third to the sixth session. However, these differences were eliminated with training.
  
  
  CONCLUSIONS
  Known gender differences in visuospatial ability and manual dexterity may explain the initial gender differences in the quality of the final product. However, these differences were not present by the end of the training sessions. Therefore, with training, no difference in surgical technical ability was found between male and female novice surgeons.
authors.affiliation: Imperial College Academic Surgical unit, St. Marys' Hospital, Paddington, United Kingdom. dhalia.masud@doctors.org.uk
authors.forename: Dhalia
authors.initials: D
authors.lastname: Masud
authors.forename: Shabnam
authors.initials: S
authors.lastname: Undre
authors.forename: Ara
authors.initials: A
authors.lastname: Darzi
mesh_terms: D000714:Anastomosis, Surgical; D002983:Clinical Competence; D004504:Education, Medical, Undergraduate; D005260:Female; D013502:General Surgery / Q000193:education*; D006801:Humans; D007421:Intestine, Small / Q000601:surgery*; D008297:Male; D012727:Sex Characteristics; D013536:Suture Techniques