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Original Investigation
May 2017

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

Author Affiliations
  • 1Pritzker School of Medicine, University of Chicago, Chicago, Illinois
  • 2Perelman School of Medicine, University of Pennsylvania, Philadelphia
  • 3Department of Internal Medicine, University of Chicago, Chicago, Illinois
JAMA Intern Med. 2017;177(5):651-657. doi:10.1001/jamainternmed.2016.9616
Key Points

Question  How does gender affect the evaluation of emergency medicine residents throughout residency training?

Findings  In this longitudinal, retrospective cohort study of 33 456 direct-observation evaluations from 8 emergency medicine training programs, we found that the rate of milestone attainment was higher for male residents throughout training across all subcompetencies. By graduation, this gap was equivalent to more than 3 months of additional training.

Meaning  The rate of milestone attainment throughout training is significantly higher for male than female residents across all emergency medicine subcompetencies, leading to a wide gender gap in evaluations that continues until graduation.

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.

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