Published: 2021-05-28

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, Syed Asghar Naqi, Zahra Sattar, Farwa Inayat, Ali Hadi, Ahmed Usman Khalid


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.


Surgery, Residency, Gender discrimination, Operative procedures, Stress

Full Text:



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.