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    Original Investigation
    Medical Education
    July 16, 2020

    Association of Gender With Learner Assessment in Graduate Medical Education

    Author Affiliations
    • 1Division of General Internal Medicine and Geriatrics, Department of Internal Medicine, Emory University School of Medicine, Atlanta, Georgia
    • 2Division of Gastroenterology, Department of Medicine, Massachusetts General Hospital, Boston
    • 3Massachusetts General Hospital Biostatistics Center, Boston, Massachusetts
    • 4Department of Global Health, Boston University School of Public Health, Boston, Massachusetts
    • 5Department of Medicine, University of Louisville, Louisville, Kentucky
    • 6Department of Medicine, University of Chicago, Chicago, Illinois
    • 7Department of Pediatrics, University of Chicago, Chicago, Illinois
    • 8Division of General Internal Medicine, Department of Medicine, University of Alabama at Birmingham School of Medicine
    • 9Division of Hospital Medicine, Department of Medicine, University of California, San Francisco
    • 10Division of General Internal Medicine, Department of Medicine, University of California, San Francisco
    • 11Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Boston
    JAMA Netw Open. 2020;3(7):e2010888. doi:10.1001/jamanetworkopen.2020.10888
    Key Points español 中文 (chinese)

    Question  How is gender associated with faculty assessment of internal medicine resident performance?

    Findings  In this multisite cross-sectional study, resident gender was associated with differences in faculty assessments of resident performance, and differences were linked to postgraduate year. With both male and female faculty evaluators, female residents’ scores displayed a peak-and-plateau pattern whereby assessment scores peaked in postgraduate year 2.

    Meaning  These findings suggest that gender of trainees and faculty is associated with resident assessment.

    Abstract

    Importance  Gender bias may affect assessment in competency-based medical education.

    Objective  To evaluate the association of gender with assessment of internal medicine residents.

    Design, Setting, and Participants  This multisite, retrospective, cross-sectional study included 6 internal medicine residency programs in the United States. Data were collected from July 1, 2016, to June 30, 2017, and analyzed from June 7 to November 6, 2019.

    Exposures  Faculty assessments of resident performance during general medicine inpatient rotations.

    Main Outcomes and Measures  Standardized scores were calculated based on rating distributions for the Accreditation Council for Graduate Medical Education’s core competencies and internal medicine Milestones at each site. Standardized scores are expressed as SDs from the mean. The interaction of gender and postgraduate year (PGY) with standardized scores was assessed, adjusting for site, time of year, resident In-Training Examination percentile rank, and faculty rank and specialty.

    Results  Data included 3600 evaluations for 703 residents (387 male [55.0%]) by 605 faculty (318 male [52.6%]). Interaction between resident gender and PGY was significant in 6 core competencies. In PGY2, female residents scored significantly higher than male residents in 4 of 6 competencies, including patient care (mean standardized score [SE], 0.10 [0.04] vs 0.22 [0.05]; P = .04), systems-based practice (mean standardized score [SE], −0.06 [0.05] vs 0.13 [0.05]; P = .003), professionalism (mean standardized score [SE], −0.04 [0.06] vs 0.21 [0.06]; P = .001), and interpersonal and communication skills (mean standardized score [SE], 0.06 [0.05] vs 0.32 [0.06]; P < .001). In PGY3, male residents scored significantly higher than female patients in 5 of 6 competencies, including patient care (mean standardized score [SE], 0.47 [0.05] vs 0.32 [0.05]; P = .03), medical knowledge (mean standardized score [SE], 0.47 [0.05] vs 0.24 [0.06]; P = .003), systems-based practice (mean standardized score [SE], 0.30 [0.05] vs 0.12 [0.06]; P = .02), practice-based learning (mean standardized score [SE], 0.39 [0.05] vs 0.16 [0.06]; P = .004), and professionalism (mean standardized score [SE], 0.35 [0.05] vs 0.18 [0.06]; P = .03). There was a significant increase in male residents’ competency scores between PGY2 and PGY3 (range of difference in mean adjusted standardized scores between PGY2 and PGY3, 0.208-0.391; P ≤ .002) that was not seen in female residents’ scores (range of difference in mean adjusted standardized scores between PGY2 and PGY3, −0.117 to 0.101; P ≥ .14). There was a significant increase in male residents’ scores between PGY2 and PGY3 cohorts in 6 competencies with female faculty and in 4 competencies with male faculty. There was no significant change in female residents’ competency scores between PGY2 to PGY3 cohorts with male or female faculty. Interaction between faculty-resident gender dyad and PGY was significant in the patient care competency (β estimate [SE] for female vs male dyad in PGY1 vs PGY3, 0.184 [0.158]; β estimate [SE] for female vs male dyad in PGY2 vs PGY3, 0.457 [0.181]; P = .04).

    Conclusions and Relevance  In this study, resident gender was associated with differences in faculty assessments of resident performance, and differences were linked to PGY. In contrast to male residents’ scores, female residents’ scores displayed a peak-and-plateau pattern whereby assessment scores peaked in PGY2. Notably, the peak-and-plateau pattern was seen in assessments by male and female faculty. Further study of factors that influence gender-based differences in assessment is needed.

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