A comparison of operative autonomy between men and women in orthopaedic surgical training in Aotearoa New Zealand.

AIM: Recent studies have shown that women training in surgical and procedural specialties achieve less operative autonomy during training than men do. The aim of this study was to discern if there is a disparity in surgical autonomy for orthopaedic trainees by gender. METHODS: This was a retrospective study of operative procedures performed by 53 orthopaedic trainees (43 men, 10 women) in Aotearoa New Zealand over 10 years. The main outcome measure was the amount of surgical autonomy afforded to individual trainees as recorded in the training logbook, categorised as assisting a: primary surgeon with consultant scrubbed or present; or, primary surgeon unsupervised and teaching a colleague the procedure. RESULTS: Data was obtained for 41,622 procedures in total. Eighty point seven percent were performed by men and 19.3% by women. On average men performed 229 cases per year and women performed 251 cases per year. There was an overall significant difference in autonomy between men and women (p <0.001), with men performing more procedures unsupervised than women (45% of all cases versus 39% of all cases). This difference remained significant when trainee year group was accounted for. CONCLUSIONS: We conclude that women orthopaedic trainees in Aotearoa New Zealand perform fewer cases with meaningful autonomy than men. This disparity may have implications for the quality of training received by men versus women.

The role of routine assays of serum amylase and lipase for the diagnosis of acute abdominal pain.

INTRODUCTION: We aimed to evaluate the role of routine measurements of serum amylase and lipase in the diagnosis of acute abdominal pain. PATIENTS AND METHODS: We identified all patients who had serum amylase and lipase assays over a 62-day period at a single university teaching hospital and reviewed their case notes. RESULTS: We excluded 58 of the 1598 patients on grounds of ineligibility (< 18 years of age and those transferred from other hospitals). A complete data set was obtained for 1520 (98.7%) of the remaining 1540 patients. Only 9.1% of requests were based on a clinical suspicion of acute pancreatitis. Of the 44 (2.9%) patients who had acute pancreatitis, only 28 (63.6%) had an associated rise in serum amylase and/or lipase 3 times above the maximum reference range, the remainder being diagnosed radiologically. At this cut-off range, the sensitivity and specificity for serum amylase were 50% and 99%, and those for serum lipase 64% and 97%, respectively. CONCLUSIONS: Routine measurements of serum amylase and lipase are unhelpful in the diagnosis of acute abdominal pain unless there is clinical suspicion of acute pancreatitis. In these patients, assay of lipase alone is preferable to assay of amylase alone or both enzymes.