Public Release: 

Gender bias may hamper evaluations of female emergency medicine residents

Gap in rankings between males and females widens as training advances

University of Pennsylvania School of Medicine

PHILADELPHIA - Implicit gender bias has long been suspected in many medical training programs, but until recently has been difficult to study objectively. Now, for the first time, a nationally standardized milestone evaluation system for emergency medicine residents is shining a light on these potential biases. In study published today in JAMA Internal Medicine, researchers found that although male and female emergency medicine specialists start off residency on an equal playing field, by the end of the three-year training program male residents, on average, received higher evaluations on all 23 emergency medicine training categories - including medical knowledge, patient safety, team management, and communication.

During the first year of training, female residents actually scored slightly higher than males on 15 of the 23 areas, with notably higher scores in accountability, multitasking, and diagnosis. However, by the end of the third and final year of residency, males had gained higher scores in all 23 categories and had a 13 percent higher rate of milestone attainment per year - the equivalent of 3 to 4 months of additional training by graduation.

"We are concerned that the disparity we discovered in evaluations may point to an implicit bias," said co-lead author Daniel O'Connor, a student in the Perelman School of Medicine at the University of Pennsylvania. "Our finding, that female residents in emergency medicine receive lower scores than males across all sub-competencies really implicates bias rather than a deficit in specific skills or knowledge."

O'Connor and researchers from the University of Chicago Pritzker School of Medicine collected 33,456 "milestone" evaluations, from 359 emergency medicine residents over a two-year period. One-third (122) of the residents were female; two-thirds (237) were male. The training programs studied represent a mix of rural, suburban, and urban hospitals and included small, medium and large academic as well as community hospital programs.

About a third of the faculty physicians who evaluated the trainees were female (91) and two-thirds were male (194). Male and female faculty members evaluated residents similarly, consistently giving female residents lower scores throughout residency years two and three.

Although senior residents, for example, are expected to display stereotypically male characteristics such as assertiveness and independence, female residents who display such qualities may incur a penalty, even among their female role models, for violating customary gender roles.

"One way to interpret our findings is that a widening gender gap is attributable to the cumulative effects of repeated disadvantages and biases that become increasingly pronounced at the more senior levels of training," the authors wrote.

In light of recent national discussions calling for formalized competency demonstrations before residents can graduate in their specialty, this implicit bias could have long-term implications for female physicians.

"Based on our results," O'Connor said, "this would mean female residents could be required to complete additional training to graduate at the same level as their male counterparts."

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The National Institutes of Health, through a National Center for Advancing Translational Sciences' Grant (UL1 TR000430), helped support this study along with a Diversity Research Grant from the University of Chicago. Usama Qadri, a medical student at the University of Chicago, also contributed to this study.

For more information about this study, see the full press release from the University of Chicago.

Penn Medicine is one of the ./world's leading academic medical centers, dedicated to the related missions of medical education, biomedical research, and excellence in patient care. Penn Medicine consists of the Raymond and Ruth Perelman School of Medicine at the University of Pennsylvania(founded in 1765 as the nation's first medical school) and the University of Pennsylvania Health System, which together form a $5.3 billion enterprise.

The Perelman School of Medicine has been ranked among the top five medical schools in the United States for the past 18 years, according to U.S. News & World Report's survey of research-oriented medical schools. The School is consistently among the nation's top recipients of funding from the National Institutes of Health, with $373 million awarded in the 2015 fiscal year.

The University of Pennsylvania Health System's patient care facilities include: The Hospital of the University of Pennsylvania and Penn Presbyterian Medical Center -- which are recognized as one of the nation's top "Honor Roll" hospitals by U.S. News & World Report -- Chester County Hospital; Lancaster General Health; Penn Wissahickon Hospice; and Pennsylvania Hospital -- the nation's first hospital, founded in 1751. Additional affiliated inpatient care facilities and services throughout the Philadelphia region include Chestnut Hill Hospital and Good Shepherd Penn Partners, a partnership between Good Shepherd Rehabilitation Network and Penn Medicine.

Penn Medicine is committed to improving lives and health through a variety of community-based programs and activities. In fiscal year 2015, Penn Medicine provided $253.3 million to benefit our community.

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