 Okay, Lydia stays up here and she will talk about the role of gender in ophthalmic surgery training. Thank you so much. And I'll go over this quickly because it's already late afternoon and I gave a grand round's talk on this topic, but I started my grand round's talk if anybody wasn't there with this quote of a father and a son that got in a car crash and I rushed to the hospital. The father dies and then the boy is taken to the operating room and the surgeon says I can't operate on this boy because he's my son, how is that possible? And I already gave away the answer, but the surgeon is the mother and it takes many people a long time to get to that point of realizing that the surgeon is the mother and that is called unconscious bias or also known as implicit bias, which is a learned assumption or belief or an attitude that exists in our subconscious, so in an area that we are not even aware of. It is developed over time and through life experiences and also by being exposed to different stereotypes and it encompasses both favorable as well as unfavorable assessments that are activated involuntarily and without the individual's awareness or intent and being aware of becoming aware of this unconscious bias is a very important factor to overcome it. And gender bias is one type of this unconscious bias and the reason why I just want to talk about it again here is to kind of bring it to all of our attention, how important it is to think about it. And I showed this before, but if we Google of terminology on Wikipedia, there's a picture of all male surgeons operating. And I think it's important in our minds to know that women are also atomic surgeons. So my QI project is to has the aim to look at whether we have unconscious gender bias in our atomic surgery training here at the Moran. And there's a lot of literature out that I'm not going to go over again. That shows that in, for example, cataract surgery or in other field within the field of ophthalmology, there is a gender bias. And the study that I am involved in for my QI project is a retrospective analysis of the ACGME locked surgery cases from the Moran residents. I have so far looked at the past five years and analyzed male versus female residents, cases primary versus assisting as well as I've laid a focus on different subspecialty cases. And we have a small number of only 18, 18 residents that were included, but luckily these numbers are going to increase in July. So I'm excited to get some more numbers. The limitation is again the small number of individuals and that we switched from three to four residents within that timeframe. The COVID pandemic likely affected the surgical numbers and led to a fluctuation of total numbers with time. And then individuals may also lock their cases differently kind of stopping to report cases when they've reached the minimum number that is required, for example, or inaccurately logging different cases. But overall what we see is there's a non-significant trend of a higher number of surgeries in male versus female residents. It was not significant in any of the subspecialties. And when we take all of the subspecialty cases together, we do see that there is a non-significant trend, which will be very important to monitor over time and also to see if this is decreasing with increased numbers of residents or if it will increase with increased numbers of residents and analyzed. With cataract cases, there is not as big of a difference, which likely is due to the fact that the cataract cases are done at the VA, where whichever resident is there just gets the cases and it's not dependent on anyone handing over cases to the resident. So in conclusion, gender does play a role in atomic surgery and in atomic surgery training and it is often unconscious bias. And that more and we do see a non-significant trend of higher surgical numbers for men compared to women, especially in non-cataract cases. But larger studies are needed to truly understand the gender bias and kind of the trend over time. So the next step will be to increase these numbers by including surgical locks from the soon to be graduating class of 2023. And then we also want to look back and include the data from the past 10 years to see if we can find any trends at the Moran over time. But the most important thing is to raise awareness to everyone here at Moran of this unconscious bias so this can be eliminated in the future. And with that, I would like to thank Dr. Simpson and Dr. Larshall as well as Elaine who have helped me with the study. Thank you. Questions, comments? It's awesome work, super important. Just a quick question. I can't remember if you talked about this before, but do you think there's a way to look at differences in recording too and like in the way that they're recorded? It's tough. It's not the surgery locks, but it's very difficult to like say if people just under reported it, like definitely for injections, like some people reported their 30 injections or so and then stopped where we do way more than 30 injections during our residency. But I think that people are doing their best with logging and it's just a bias that we can't eliminate. Yeah, exactly. There's like, as far as like saying whether or not your primary surgeon, there's like there's a lot of subjectivity to it. And I wonder how that. Well, as a class, what we have typically done is we have come up with rules as to when we are primary surgeons. So for example, for cataract surgery, when we are doing their access, that's when we count it as a primary case. Or for other cases, if you do more than half, I don't know, more than 50 percent of it, but just having consistency within the class is something that's important. But yeah, I don't think you can really look at that later on. Yeah, no, I like to make that point. I mean, on some level, it's just it's a part of bias that's going to be in there. And, you know, you really can't control for it. But anyone who's attended the Education, you know, committee meeting over the past, you know, five, 10 years knows invariably every year there will be someone outlying and you'll have someone with 10 times the number of something. And that's Bill Barlow's main job is making sure that those definitions are common. Same thing with work hours. Work hours are reported reported quite variably. And this this I very much is very real, right? This is this is not something that we can certainly just dismiss by variations in someone reporting VA. It's it's all it's actually about three quarters of the surgery in general is done at the VA for cataracts. So I don't think we can ascribe that all to just whoever does it is there. In fact, my kind of anecdotal experience is VA numbers can be can can be impacted significantly just by the person really being aggressive in their month. Dr. Jebaraj, being a wonderful example of it, because she at one point this year was behind and came into the VA and just being very proactive, making sure that she had the case of scheduled. She was calling to make sure patients for showing up, not canceling. And she had some of the, you know, biggest possible months she could have because of that. So in short, this is something we absolutely will track and we need to understand better why those trends are there. Small numbers and yet with the information we have right now, this is something we need to be keenly aware of.