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Comparison of Male vs Female Resident Milestone Evaluations by Faculty During Emergency Medicine Residency Training.

Abstract：

Importance:Although implicit bias in medical training has long been suspected, it has been difficult to study using objective measures, and the influence of sex and gender in the evaluation of medical trainees is unknown. The emergency medicine (EM) milestones provide a standardized framework for longitudinal resident assessment, allowing for analysis of resident performance across all years and programs at a scope and level of detail never previously possible. Objective:To compare faculty-observed training milestone attainment of male vs female residency training. Design, Setting, and Participants:This multicenter, longitudinal, retrospective cohort study took place at 8 community and academic EM training programs across the United States from July 1, 2013, to July 1, 2015, using a real-time, mobile-based, direct-observation evaluation tool. The study examined 33 456 direct-observation subcompetency evaluations of 359 EM residents by 285 faculty members. Main Outcomes and Measures:Milestone attainment for male and female EM residents as observed by male and female faculty throughout residency and analyzed using multilevel mixed-effects linear regression modeling. Results:A total of 33 456 direct-observation evaluations were collected from 359 EM residents (237 men [66.0%] and 122 women [34.0%]) by 285 faculty members (194 men [68.1%] and 91 women [31.9%]) during the study period. Female and male residents achieved similar milestone levels during the first year of residency. However, the rate of milestone attainment was 12.7% (0.07 levels per year) higher for male residents through all of residency (95% CI, 0.04-0.09). By graduation, men scored approximately 0.15 milestone levels higher than women, which is equivalent to 3 to 4 months of additional training, given that the average resident gains approximately 0.52 levels per year using our model (95% CI, 0.49-0.54). No statistically significant differences in scores were found based on faculty evaluator gender (effect size difference, 0.02 milestone levels; 95% CI for males, -0.09 to 0.11) or evaluator-evaluatee gender pairing (effect size difference, -0.02 milestone levels; 95% CI for interaction, -0.05 to 0.01). Conclusions and Relevance:Although male and female residents receive similar evaluations at the beginning of residency, the rate of milestone attainment throughout training was higher for male than female residents across all EM subcompetencies, leading to a gender gap in evaluations that continues until graduation. Faculty should be cognizant of possible gender bias when evaluating medical trainees.

journal_name

JAMA Intern Med

journal_title

JAMA internal medicine

authors

Dayal A,O'Connor DM,Qadri U,Arora VM

doi

10.1001/jamainternmed.2016.9616

subject

Has Abstract

pub_date

2017-05-01 00:00:00

pages

651-657

issue

eissn

2168-6106

issn

2168-6114

pii

2607209

journal_volume

177

pub_type

杂志文章

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Comparison of Male vs Female Resident Milestone Evaluations by Faculty During Emergency Medicine Residency Training.