SheMD Journal Club: Differences in Emergency Medicine Resident Procedural Reporting by Gender in the United States

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Link to Article: https://jgme.kglmeridian.com/view/journals/jgme/16/1/article-p70.xml

Why is this article important?

We’ve spent years studying gender differences in evaluations, feedback, and operative experience. But in Emergency Medicine, where procedural competence is core to training, we’ve had surprisingly little data on something fundamental: Do men and women residents actually get the same procedural experience?

Because in EM, opportunity = experience = competence = confidence.

Article Summary

What they looked at: Whether there are gender differences in the number of procedures performed (and reported) by Emergency Medicine residents.

How they measured things:

• Retrospective review of procedure logs from 8 EM residency programs

• Timeframe: 2013–2022

• 880 residents included (358 women, 522 men)

• Compared procedural counts by gender using regression analysis, controlling for institution

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What were their outcomes:

• Most procedures showed no significant gender difference

• However, men performed more of several key procedures, including:

  • Dislocation reductions

  • Chest tube insertions

  • Sedations

• On sensitivity analysis, central lines were also higher among men

Importantly, all residents exceeded ACGME minimums—but differences still existed within that range.

Why do we care about this article?

What does this mean?

At first glance, this feels reassuring: Most procedures? No difference.

But the details matter.

1. Not all procedures are equal

The differences showed up in:

• Lower-frequency procedures

• Higher-stakes procedures

• Procedures that often require assertiveness + timing + access

These are exactly the moments where:

• Confidence grows

• Autonomy develops

• Identity as a proceduralist forms

2. Opportunity is not evenly distributed

This study doesn’t tell us why the differences exist—but prior literature gives us clues:

• Differences in assertiveness or self-advocacy

• Differences in faculty entrustment/autonomy

• Subtle differences in who gets offered the procedure

• Environmental factors (resus vs procedural service, etc.)

This is rarely explicit. It’s often quiet, cumulative, and invisible in real time.

3. “Meeting minimums” doesn’t mean equity

All residents met ACGME requirements.

But:

• Minimums ≠ mastery

• Minimums ≠ confidence

• Minimums ≠ equal experience

And small differences over time can compound into:

• Procedural comfort

• Fellowship decisions

• Career trajectory

4. This is a systems issue, not an individual one

It would be easy—but incorrect—to frame this as: “Some residents just seek out procedures more.”

The better question is: Who gets encouraged, trusted, and offered opportunities—and when?

The takeaway:

In EM training, equity isn’t just about evaluation, it’s about access in the moment.

Because the difference between watching and doing… is where physicians are made.

Similar Articles

• Dayal et al. Gender differences in EM milestone evaluations

  • https://pubmed.ncbi.nlm.nih.gov/28264090/

• Mueller et al. Gender differences in feedback to residents

  • https://pubmed.ncbi.nlm.nih.gov/29075375/

• Chen et al. Gender disparities in surgical autonomy

  • https://pubmed.ncbi.nlm.nih.gov/34721795/