Association of Gender with Learner Assessment in Graduate Medical Education

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