Description

Show Notes for Podcast Nine of seX & whY

Host: Jeannette Wolfe

Guests: Dr. Dan O'Connor, Dr. Anna Mueller

Topic: Gender Differences in Resident Evaluation

Welcome back to Sex and Why. In this episode I am joined by Dr. Dan O'Connor, a dermatology resident at Harvard and co-founder of Monte Carlo software that makes apps for medical educators, and Dr. Anna Mueller, who is a medical sociologist and Professor in the Department of Comparative Human Development at the University of Chicago. They are here to discuss their research showing gender disparities in evaluations of emergency medicine residents. 

First study

Comparison of Male vs Female Resident Milestone Evaluations by Faculty During Emergency Medicine Residency Training. JAMA Internal Medicine 2017

This study examined data from a real time milestone evaluation app used on emergency medicine residents. It involved 356 residents (66% male 34% female) and 285 faculty (68% male and 32% female) at 8 different sites and included over 33,000 evaluations. They showed that although male and female residents had similar evaluations during their first year of training, by their 3rd year male residents were evaluated statistically higher across all 23 core competencies and this occurred regardless of the gender of the evaluator.

Second study

Gender Differences in Attending Physicians' Feedback to Residents: A Qualitative Analysis. Journal of Graduate Medical Education 

This follow up study was done to better understand why there are gender differences in the evaluations and focused on a qualitative analysis of comments written about third year residents at one of the above program sites. It involved analyzing and creating summaries of individual residents (who had at least 15 written evaluations) and included an analysis of over 1000 comments on more than 45 residents.

General findings:

• Evaluations often contained personality related comments even when the task that was being evaluated was objective or technical
• Men, compared to women, appeared to have more comments associated with praise versus criticism around these personality related comments
• Men appeared to have more concordant feedback by evaluators concerning how to improve in areas in which they struggled
• Women received more discordant feedback about ways to do things better in areas in which they struggled especially surrounding issues about autonomy and leadership
• Evaluators perceived that women were less likely than men to receive feedback appropriately.
• Evaluators were more likely to include encouraging comments concerning "a sense of belonging" to male residents

Steps moving forward

• Take a deep breath- this is difficult stuff to discuss and it can easily feel like an attack upon our character.
• Come to terms that this data is real and legit. This topic is incredibly important and we need to consciously move past our own visceral discomfort of it to find better ways to teach and evaluate the next generation of doctors.
• Do a private audit of your own evaluations
• Be more objective in suggestions for improvement
• Reinforce a sense of belief in ability and of belonging

 Stay tuned for next month in which we will tackle feedback.

Dayal, A., O'Connor, D. M., Qadri, U., & Arora, V. M. (2017). Comparison of Male vs Female Resident Milestone Evaluations by Faculty During Emergency Medicine Residency Training. JAMA Internal Medicine, 177(5), 651. https://doi.org/10.1001/jamainternmed.2016.9616

Mueller, A. S., Jenkins, T. M., Osborne, M., Dayal, A., O'Connor, D. M., & Arora, V. M. (2017). Gender Differences in Attending Physicians' Feedback to Residents: A Qualitative Analysis. Journal of Graduate Medical Education, 9(5), 577–585. http://www.jgme.org/doi/10.4300/JGME-D-17-00126.1

Additional studies we talked about

MRI study about political views- evaluated how individuals with definitive political views may process contradictory information differently than individuals with more flexible mindsets.  Kaplan, J. T., Gimbel, S. I., & Harris, S. (2016). Neural correlates of maintaining one's political beliefs in the face of counterevidence. Scientific Reports, 6, 39589. Retrieved from http://dx.doi.org/10.1038/srep39589

Thoracic surgery study that suggests that male surgical fellows may actually receive more advanced operative experience than their female matched peers

Meyerson, S. L., Sternbach, J. M., Zwischenberger, J. B., & Bender, E. M. (2017). The Effect of Gender on Resident Autonomy in the Operating room. Journal of Surgical Education, 74(6), e111–e118. https://doi.org/10.1016/j.jsurg.2017.06.014

JAMA study perceiving gender differences in implicit bias in academic medicine

Jagsi  R, Griffith  KA, Jones  R, Perumalswami  CR, Ubel  P, Stewart  A.  Sexual harassment and discrimination experiences of academic medical faculty.  JAMA. 2016;315(19):2120-2121. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5526590/