Association of Gender With Learner Assessment in Graduate Medical Education

• Type of Material: Article
• Authors: Robin Klein, Emory University; Nneka N. Ufere, Massachusetts General Hospital; Sowmya R. Rao, Massachusetts General Hospital; Jennifer Koch, University of Louisville; Anna Volerman, University of Chicago; Erin D. Snyder, University of Alabama Birmingham; Sarah Schaeffer, University of California San Francisco; Vanessa Thompson, University of California San Francisco; Ana Sofia Warner, Massachusetts General Hospital; Katherina A. Julian, University of California San Francisco; Kerri Palamara, Massachusetts General Hospital
• Language: English
• Date: 2020-07-16
• Publisher: American Medical Association
• Publication Version: Final Published Version
• Copyright Statement: © 2020 Klein R et al. JAMA Network Open.
• License: Creative Commons Attribution 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1001/jamanetworkopen.2020.10888
• Title of Journal or Parent Work: JAMA Network Open
• Volume: 3
• Issue: 7
• Start Page: e2010888
• End Page: e2010888
• Grant/Funding Information: his study was supported by the Josiah Macy Jr. Foundation President’s Grant (Dr Klein) and the Center for Educational Innovation and Scholarship Grant from Massachusetts General Hospital (Dr Palamara).
• Keywords: Life Sciences & Biomedicine; Residents; Women; Science & Technology; General & Internal Medicine; Faculty; Bias; Sex differences; Medicine, General & Internal
• Research Categories: Health Sciences, Health Care Management; Biology, Biostatistics; Health Sciences, Nursing; Education, Health

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.