SheMD Journal Club: Gender Bias in Resident Assessment in Graduate Medical Education

Here at sheMD, we believe in the importance of practicing Evidence-Based Medicine. We believe the same principles apply to discussing Gender and Medical Education. Therefore, we are bringing you an entire Journal Club series! Our series will focus on foundational and new literature within the gender and medicine space.

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https://link.springer.com/article/10.1007/s11606-019-04884-0

Today, we will be discussing the article entitled, Gender Bias in Resident Assessment in Graduate Medical Education: Review of the Literature.

Why is this article important?

• Feedback is a huge part of medical education, and students, residents, and faculty all rely on accurate and fair student feedback as an assessment tool for performance and evaluation.

• Implicit gender bias in medical education threatens the integrity of student and resident assessment and affects the ability of programs to give meaningful feedback, which can affect ability to match and/or advance.

Article Summary

What they looked at:

• The researchers utilized a comprehensive literature review looking for articles with subjects on gender in graduate medical education.

• They focused on original research with publication dates between 1998 and 2018, and articles were blinded before determining inclusion into the review. Nine studies were included in the final review. Over 38,000 resident reviews and 10,000 feedback narratives were included from family medicine, internal medicine, OBGYN, and emergency medicine practices.

What were their outcomes:

• While there was initially no difference over twenty-three milestones between males and females during intern year, there were statistically significant differences in all of them by third year of residency with males having a higher rate of milestone attainment.

• Another study found male resident scores were higher in six of nine domains, and male faculty rated male residents higher than female residents in all nine domains.

• In feedback opportunities from nursing staff, female residents received lower scores (p=0.001), fewer positive comments, and more negative comments (p=0.04) than male residents.

• Female residents were more likely to receive discordant feedback from faculty, especially when regarding autonomy, assertiveness, and receptiveness.

• Five of the nine studies reported significant differences in resident performance metrics attributed to differences in gender.

Why do we care about this article?

What does this mean?

• Gender bias is multifaceted and may lead to inconsistent feedback.

• The source of gender bias in assessment is not known, but some suspected contributing factors may be differences between gender normative behaviors and professional roles and differences in how faculty assess residents.

How does this apply to us?

• Resident assessment is competency and performance based, so the accuracy of them is critical.

• Differences between genders in resident assessments may have a negative impact on residency training experience, career trajectory, and earning potential.

• Intervention is necessary to combat gender bias in resident assessment by open conversation and recognition in faculty development.

Take Home Point

• While gender differences in resident assessment is a challenging topic to study, it is a critical component of graduate medical education and the impact on learners should be continually highlighted.

Similar Articles

• For further reading on the topic, check out these articles!

• Brown MEL, Hunt GEG, Hughes F, Finn GM. 'Too male, too pale, too stale': a qualitative exploration of student experiences of gender bias within medical education. BMJ Open. 2020 Aug 13;10(8):e039092. doi: 10.1136/bmjopen-2020-039092. PMID: 32792453; PMCID: PMC7430333.

• Kramer M, Heyligers IC, Könings KD. Implicit gender-career bias in postgraduate medical training still exists, mainly in residents and in females. BMC Med Educ. 2021 May 2;21(1):253. doi: 10.1186/s12909-021-02694-9. PMID: 33933035; PMCID: PMC8088689.

• Llorens A, Tzovara A, Bellier L, Bhaya-Grossman I, Bidet-Caulet A, Chang WK, Cross ZR, Dominguez-Faus R, Flinker A, Fonken Y, Gorenstein MA, Holdgraf C, Hoy CW, Ivanova MV, Jimenez RT, Jun S, Kam JWY, Kidd C, Marcelle E, Marciano D, Martin S, Myers NE, Ojala K, Perry A, Pinheiro-Chagas P, Riès SK, Saez I, Skelin I, Slama K, Staveland B, Bassett DS, Buffalo EA, Fairhall AL, Kopell NJ, Kray LJ, Lin JJ, Nobre AC, Riley D, Solbakk AK, Wallis JD, Wang XJ, Yuval-Greenberg S, Kastner S, Knight RT, Dronkers NF. Gender bias in academia: A lifetime problem that needs solutions. Neuron. 2021 Jul 7;109(13):2047-2074. doi: 10.1016/j.neuron.2021.06.002. PMID: 34237278; PMCID: PMC8553227.

• See A, Pallaci M, Aluisio AR, Beck-Esmay J, Menchine M, Weinstock M, Lam CN, Riddell J. Assessment of Implicit Gender Bias During Evaluation of Procedural Competency Among Emergency Medicine Residents. JAMA Netw Open. 2022 Feb 1;5(2):e2147351. doi: 10.1001/jamanetworkopen.2021.47351. PMID: 35129594; PMCID: PMC8822382.

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