General surgery resident’s perspective towards general surgery residency in Pakistan and allotment of surgical cases to them: a cross sectional study


  • Ahmed Siddique Ammar Department of General Surgery, East Surgical Ward, Mayo Hospital, Lahore, Pakistan
  • Syed Asghar Naqi Department of Surgery, East Surgical Ward, Mayo Hospital, Lahore, Pakistan
  • Zahra Sattar Department of General Surgery, East Surgical Ward, Mayo Hospital, Lahore, Pakistan
  • Farwa Inayat Department of General Surgery, East Surgical Ward, Mayo Hospital, Lahore, Pakistan
  • Ali Hadi Department of General Surgery, East Surgical Ward, Mayo Hospital, Lahore, Pakistan
  • Ahmed Usman Khalid Department of Ophthalmology, Hayatabad Medical Complex, Peshawar, Pakistan



Surgery, Residency, Gender discrimination, Operative procedures, Stress


Background: General surgery residency is considered a stressful field with residents facing many problems including learning operative procedures, competition with fellow colleagues, gender discrimination and balancing their marital and family life.

Methods: A cross-sectional study was conducted using a self-structured questionnaire, containing questions about perspective of general surgical residents about residency structure and problems in Pakistan and about allotment of surgical procedures to them. A total of 1624 general surgical residents were conveniently enrolled in this study from different tertiary care hospitals of Pakistan.

Results: Mean age of residents was 29 years (range 24-35 years).70.44% of residents were male while 29.55% were female. Majority of the residents were from 2nd year residency (30.66%). 889 (54.7%) of the residents thought that the general surgery residency had put negative effects on their family and marital life while 1365 (84%) stated that they suffered from anxiety depression sleep deprivation at some time during the residency (p<0.01). 864 (53.2%) residents disagreed that surgical procedures are allotted according to the year of residency.901 (55.4%) residents were not sure that buttering their seniors will get them more cases. 887 (54.6%) were unsure about gender discrimination in the general surgery (p<0.01).

Conclusions: Gender discrimination in general surgery is now obsolete. Main factor in the allotment of operative procedure is the responsible behaviour of the resident, past operative records and level of pre-and post-operative care of the patients. Grid system should be adopted for the allotment of surgical procedures.


Bansal N, Simmons KD, Epstein AJ, Morris JB, Kelz RRJJs. Using patient outcomes to evaluate general surgery residency program performance. JAMA Surg. 2016;151(2):111-9.

Lebares CC, Guvva EV, Ascher NL, O'Sullivan PS, Harris HW, Epel ESJJotACoS. Burnout and stress among US surgery residents: psychological distress and resilience. J Am Coll Surg. 2018;226(1):80-90.

Yaow CYL, Mok HT, Ng CH, Devi MK, Iyer S, Chong CSJJose. Difficulties Faced by General Surgery Residents. A Qualitative Systematic Review. J Surg Educ. 2020.

Uppgaard RJJoO, Surgery M. Addressing gender discrimination in oral and maxillofacial surgery via the social norms approach. J Oral Maxillofac Surg. 2018;76(8):1604-5.

Swendiman RA, Edmondson AC, Mahmoud NNJAoS. Burnout in surgery viewed through the lens of psychological safety. Ann Surg. 2019;269(2):234-5.

Zaheer F, Aziz I, Arif S, Khan MO, Khan AA, Osama M et al. Predicament Of Doctors; Discerning Burnout Level Amongst Surgical Residents Of Karachi, Pakistan. J Ayub Med Coll Abbottabad. 2020;32(3):331-5.

Seemann NM, Webster F, Holden HA, Carol-anne EM, Baxter N, Desjardins C, et al. Women in academic surgery: why is the playing field still not level? Am J Surg. 2016;211(2):343-9.

Hughes BD, Perone JA, Cummins CB, Sommerhalder C, Tyler DS, Bowen-Jallow KA, et al. Personality testing may identify applicants who will become successful in general surgery residency. 2019;233:240-48.

Freischlag JA, Silva MMJJS. Preventing General Surgery Residency Attrition-It Is All About the Mentoring. J Surg Res. 2017;152(3):272-3.

Hashmi M, Taqi A, Memon MI, Ali SM, Khaskheli S, Sheharyar M et al. A national survey of critical care services in hospitals accredited for training in a lower-middle income country: Pakistan. J Crit Care. 2020.

Osama M, Zaheer F, Saeed H, Anees K, Jawed Q, Syed SH et al. Impact of COVID-19 on surgical residency programs in Pakistan; A residents' perspective. Do programs need formal restructuring to adjust with the “new normal”? A cross-sectional survey study. J Minim Access Surg. 2020;79:252-6.

Zubair U, Zubair ZJJ. Surgical resident training in Pakistan and benefits of simulation based training. J Pak Med Assoc. 2020;2020.

Campbell J, Prochazka AV, Yamashita T, Gopal RJAM. Predictors of persistent burnout in internal medicine residents: a prospective cohort study. Acad Med. 2010;85(10):1630-4.

Hamid S, Inam SHA, Jamil H, Zeb RJS. Speciality preference with respect to gender among medical students of Pakistan. J Pak Med Assoc. 2019;20(11):06-37.

Elmore LC, Jeffe DB, Jin L, Awad MM, Turnbull IRJJotACoS. National survey of burnout among US general surgery residents. J Am Coll Surg. 2016;223(3):440-51.

Phillips NA, Tannan SC, Kalliainen LKJP, Surgery R. Understanding and overcoming implicit gender bias in plastic surgery. Plast Reconstr Surg. 2016;138(5):1111-6.

Nassar AH, Zern NK, McIntyre LK, Lynge D, Smith CA, Petersen RP et al. Emergency restructuring of a general surgery residency program during the coronavirus disease 2019 pandemic: the University of Washington experience. JAMA Surg. 2020.






Original Research Articles