Gender Bias in Resident Assessment in Graduate Medical Education: Review of the Literature

Abstract

BACKGROUND: Competency-based medical education relies on meaningful resident assessment. Implicit gender bias represents a potential threat to the integrity of resident assessment. We sought to examine the available evidence of the potential for and impact of gender bias in resident assessment in graduate medical education. METHODS: A systematic literature review was performed to evaluate the presence and influence of gender bias on resident assessment. We searched Medline and Embase databases to capture relevant articles using a tiered strategy. Review was conducted by two independent, blinded reviewers. We included studies with primary objective of examining the impact of gender on resident assessment in graduate medical education in the USA or Canada published from 1998 to 2018. RESULTS: Nine studies examined the existence and influence of gender bias in resident assessment and data included rating scores and qualitative comments. Heterogeneity in tools, outcome measures, and methodologic approach precluded meta-analysis. Five of the nine studies reported a difference in outcomes attributed to gender including gender-based differences in traits ascribed to residents, consistency of feedback, and performance measures. CONCLUSION: Our review suggests that gender bias poses a potential threat to the integrity of resident assessment in graduate medical education. Future study is warranted to understand how gender bias manifests in resident assessment, impact on learners and approaches to mitigate this bias.

Does Applicant Gender Have an Effect on Standardized Letters of Evaluation Obtained During Medical Student Emergency Medicine Rotations?

“…Differences in the assessment of men and women have been documented within undergraduate and graduate medical education. [18][19][20][21][22][23][24][25][26][27][28] Most notably and recently, Dayal et al 20 studied the effect of gender on milestone assessments in EM residency training programs. Dayal and colleagues found that at the beginning of training, milestone assessments tend to be similar between men and women, with women achieving higher mean scores in many categories.…”

“…Studies from undergraduate and graduate medical education have demonstrated gender differences associated with several assessment methods. [18][19][20][21][22][23][24][25][26][27][28] For example, men in EM residencies achieve higher milestone assessments than women at graduation. 20 With the revised format of the SLOE 2 and the tendency for more SLOEs to be completed by groups of EM residency and clerkship leaders, 9,15 rather than individual faculty, we sought to determine if there is any difference in the SLOE global assessment of female versus male applicants.…”

Locker (operating) room talk: Gender equity and the medical student’s perspective

“…3,4 This gender disparity persists later in residency training and as attending physicians. [5][6][7] Women in medicine do not receive the same recognition as their male colleagues in terms of leadership and salary. 8-10 These patterns might be reflecting the gendered pathways female medical students are encouraged to pursue, which tend to be lower paid and underappreciated, as are most professions and careers dominated by women.…”

Let’s Face It: We Are Biased, and It Should Not Be That Way

“…Klein et al 6 performed a systematic review of the literature from 1998 to 2018 to examine the presence and influence of gender bias on resident assessment. Five of the nine studies uncovered evidence of gender bias, with women receiving lower ratings in domains of performance and differences in qualitative comments.…”