A study by Mueller and colleagues in last month’s Journal of
Graduate Medical Education (1) looked at feedback given to emergency medicine
residents over two years of residency training. The purpose of the study was to
determine if there was a difference in the evaluations that resident received
from attending physicians based on the resident’s gender. The authors were
looking for the so-called “gender gap”.
In order to determine if there was a gender gap, the authors
performed a qualitative analysis of the evaluative comments that were made by
attending physicians during milestone observations of residents. These comments
were made in real time through a software application that was available on the
attending physician’s mobile phone or computer. The comments were made by 67
attending physicians. 29 of the 67 attending physicians were female (47%).
The cohort included two classes of PGY-3 emergency medicine
residents (n = 47). The gender breakdown of the residents included in the study
is not clear, but it appears that the analysis was primarily of residents who
received more than 15 comments during the study period. In this group of 35 residents, there were 13
(37%) who were female.
There were a total of 1317 direct observation comments made
during the two-year study period. The comments made by attending physicians
seemed to value procedural and diagnostic skills, which makes sense for
emergency medicine residents. Interestingly, the faculty also valued some
particular personality traits such as confidence, hard work, the ability to
perform under pressure, and multi-tasking.
The authors identified these characteristics as more stereotypically
masculine traits.
The authors concluded that female residents received “less
consistent feedback from attending physicians than male residents”. This was
primarily focused on the concept of the emergency medicine valued personality
traits. Female residents were more likely (no statistical analysis given) to
receive both strong praise and strong criticism than male residents (62% vs.
45%). When considering the “ideal” emergency medicine traits, 50% of the men
received negative comments compared to 77% of the women. 62 percent of the
female residents were criticized by more than one attending for their lack of
these idealized emergency medicine personality traits compared to 36% of the
male residents.
In a 2014 qualitative study, Kolehmainen and colleagues
performed semi-structured interviews with internal medicine residents who had
participated in leading CPR in a hospital resuscitation. (2) They were trying
to determine how gender influences the code leadership experience. One of the
themes from this research was that female residents felt stress from violating
“gender behavioral norms” in the role of code leader. It would be interesting
to know if the female emergency medicine residents in the Mueller study felt
pressure and stress at having to exhibit these stereotypically masculine traits
in order to receive better evaluations from their faculty physicians.
Many of you are probably thinking the same thing that I was
thinking when I read this great manuscript: what about the gender gap in the
evaluators. Interestingly, the authors did not even mention this concept. It
was as if the attending physicians were considered above reproach, which we
know is not true. Men and women evaluate differently. They value different
characteristics, and may actually treat residents differently based on the
resident’s gender.
In 2012, Moss-Racusin and colleagues (3) performed a randomized
double-blind study of science faculty who were asked to rate the application
materials of a graduate student who was applying for a laboratory position. The
student was randomly assigned either a male or female name. Faculty members rated the students with a
male name significantly higher including being more competent and offering them
a higher starting salary.
We published a study several years ago that looked at
evaluation comments made by faculty and senior residents regarding first year
residents on an inpatient rotation (4). We found some differences in the types
of comments made by senior and junior level faculty and senior residents, but
there were not enough female attendings to determine if there were any real gender
differences in the evaluators.
But half of the 67 evaluators in this study were women.
Plenty to show a difference. I would love to see the comments broken down into
the four pairs (Male faculty to Male resident, Female faculty to Female
resident, Male faculty to Female resident, Female faculty to Male resident).
The author’s conclusion that this research “contributes to
understandings of gender inequality in graduate medical education” is true, but
they could have done much more.
As usual, we invite your comments…
References
(1) Mueller AS, Jenkins TM, Osborne M, et al. Gender
Differences in Attending Physicians’ Feedback to Residents: A Qualitative
Analysis. J Grad Med Ed 2017; 10: 577-585.
(2) Kolehmainen C, Brennan M, Filut A, et al. Afraid of
being ‘‘witchy with a ‘b’: a qualitative study of how gender influences
residents’ experiences leading cardiopulmonary resuscitation. Acad Med 2014; 89 (9): 1276–1281.
(3) Moss-Racusin CA, Dovidio JF, Brescoll VL, et al. Science
faculty’s subtle gender biases favor male students. Proc Natl Acad Sci USA.
2012; 109(41): 16474–16479.
(4) Ringdahl E, Delzell JE, Kruse RL. Evaluation of interns
by senior residents and faculty: is there any difference? Medical
Education 2004; 38: 646–651.
