Female Surgeons as Counter Stereotype: The Impact of Gender Perceptions on Trainee Evaluations of Physician Faculty

Inconsistent advice by ChatGPT influences decision making in various areas

The ChatGPT technology is increasingly becoming a part of our daily lives and is starting to be utilized in various decision-making contexts. The current study builds upon prior research, demonstrating that people's moral decision-making is influenced by ChatGPT across three perspectives, as evidenced by two studies (total n = 1925). The findings suggested that ChatGPT advice impacted decision-making similarly to expert advice, although not all decisions were susceptible to influence, particularly those based on negative emotions. Additionally, ChatGPT advice affected decisions beyond moral judgments, but no effect was observed when the advice recommended immediate low rewards. Moreover, individuals with a higher tendency for personal fear of invalidity were more likely to be influenced by both expert and AI advice, but this was not related to trust in AI.

A Look at Demographics and Transition to Virtual Assessments: An Analysis of Bias in the American Board of Surgery General Surgery Certifying Exams

OBJECTIVE

The goals of this study were (1) to assess if examiner ratings in the American Board of Surgery (ABS) General Surgery Cetifying Exam (CE) are biased based on the gender, race, and ethnicity of the candidate or the examiners, and (2) if the format of delivering of the exams, in-person or virtual, affects how examiners rate candidates.

DESIGN

We included every candidate-examiner combination for first time takers of the general surgery oral exam. Total scores and pass/fail outcomes based on the 4 scores given by examiners to candidates were analyzed using multilevel models, with candidates as random effects. Explanatory variables included the gender, race, and ethnicity of candidates and examiners, and the format of the exam (in-person or virtual). Candidates' first attempt scores on the ABS General Surgery Qualifying Exam (QE) were also included in the models to control for the baseline knowledge of the candidate. Three sets of models were evaluated for each demographic variable (gender, race, ethnicity) due to missingness in data. p-values and coefficients of determination R2 were used to quantify the statistical and practical significance of the model coefficients (an existent relationship between the explored variables on CE scores was considered statistically and practically significant if the p-value was lower than 0.01 and R2 higher than 1%).

PARTICIPANTS

All first-time takers of the American Board of Surgery General Surgery Certifying Exam from 2016 to 2022 that had demographic data, and the examiners that participated in those exams.

RESULTS

The number of candidates/examiners for the 3 sets of models was 8665/514 (gender), 5906/465 (race), and 4678/295 (ethnicity). The demographic variables, format of the exam, or their interactions were not found to significantly relate to examiner-candidate ratings or pass/fail outcomes. The only variable that was significantly related to CE scores was candidates' QE scores, which was added to the models as a measure of candidates' initial knowledge; this held for all models for total scores (F[1,8659] = 1069.89, p-value < 0.01, R2 = 5% [gender models], F(1,5696.3) = 589.13, p-value < 0.01, R2 = 5% [race models], F(1,4459.5) = 278.33, p-value < 0.01, R2 = 5% [ethnicity models]), and pass/fail outcomes (CI = 1.61-1.73, p-value < 0.01, R2 = 3% [gender models], CI = 1.67-1.85, p-value < 0.01, R2 = 3% [race models], CI = 2.17-2.90, p-value < 0.01, R2 = 3% [ethnicity models]).

CONCLUSIONS

This study shows that there is not a relationship between candidate and examiner gender, race, or ethnicity, and exam outcomes based on statistical models looking at examiner-candidate ratings and pass/fail outcomes. In addition, the delivery of the certifying exam in a virtual format appears to have no statistical impact on outcomes compared to in-person delivery. This suggests that the ABS is performing well in both demographic bias and virtual space.

The Impact of Faculty Gender on Resident Evaluations of Faculty Performance in Emergency Medicine

INTRODUCTION

Gender bias impacts the promotion and tenure of female emergency medicine (EM) physicians and limits their ability to advance in academic rank. Many factors influence the promotion and tenure process including research, evaluations, opportunities for leadership, sponsorship, and mentorship. The goal of this study is to determine if resident evaluations of EM faculty differ by faculty gender.

METHODS

A quantitative analysis was used to examine 14,613 teaching evaluations of faculty by residents at a single academic center (The Ohio State University Wexner Medical Center, Columbus) in the years 2017-2019. Anonymized ratings of male and female faculty on a five-point Likert scale were compared using Fischer's exact test and adjusting for multiple comparisons.

RESULTS

Male faculty were more likely to hold the rank of Associate Professor or Professor. When taking both faculty gender and rank into account, male Clinical Instructors and Assistant Professors had significantly higher evaluation scores by residents in the domain of resident autonomy than their female counterparts. Regardless of gender or faculty rank, the majority of faculty received scores greater than four.

CONCLUSION

A significant gender difference was found in resident evaluation scores of faculty in the domain of resident autonomy at the level of Clinical Instructor and Assistant Professor. Resident autonomy refers to the degree of supervision by faculty which evolves over time and is primarily based on level of training. This is important as it demonstrates a gender difference in scores that could be used to determine faculty compensation and promotion. Evaluation tools used for promotion and tenure of academic faculty should be evaluated for implicit bias and appropriate statistical analysis.

Diversity in the Cardiothoracic Surgery Workforce: What I Can Do

Within the cardiothoracic surgery workforce, there are significant gaps in the numbers of women and underrepresented in medicine minorities, but some progress has been made in gender diversity at the resident level. Individual surgeons play an important role in combatting discrimination and harassment, while also promoting women and minorities through mentorship and sponsorship. More importantly, a multifaceted and structured approach is needed to increase diversity at the institutional level with strategies to create a culture of inclusion, working to retain underrepresented minority and female surgeons, and eliminating bias in the recruitment process.

The Importance of Perceived Barriers to Women Entering and Advancing in Orthopaedic Surgery in the US and Beyond

BACKGROUND

Global perceptions of barriers to women in orthopaedics have not been assessed. The purpose of this study was to determine the importance of international barriers to women entering and advancing within orthopaedic surgery.

METHODS

An anonymous, online survey was distributed to women medical students, trainees, and practicing surgeons via Women in Orthopaedics Worldwide, the "Women in Ortho" Facebook page, and individual programmes. Participants were asked to rate perceived barriers to (1) pursuing training and (2) career advancement on a scale of 1-5, with 5 being the most important and relative to other barriers. Descriptive statistics and univariate analyses were employed.

RESULTS

The survey yielded 237 US (84.0%) and 45 international (16.0%) respondents. Per entering orthopaedic surgery, the most important barriers were male-dominated culture, lack of a strong women mentor, and lack of female representation at home institution. Compared with the US surgeons/trainees, international respondents cited greater societal disapproval (2.8 ± 1.2 vs. 3.4 ± 1.3, P = 0.01). Medical students assigned less importance to lack of exposure, more to lack of resources for creating competitive applications (P < 0.05). Regarding career advancement, lack of women leadership, family responsibilities, and gender-biased selection for promotion were the most important. International surgeons/trainees noted greater concern for societal disapproval (3.5 ± 1.5 vs. 2.6 ± 1.3, P = 0.003) and were more likely to rank sexual harassment in their top three (17.6 vs. 4.2%, P = 0.02).

CONCLUSION

While notable differences exist, there is striking similarity across countries and position levels in perceived barriers to women entering and advancing in orthopaedic surgery.

LEVEL OF EVIDENCE

III.

Gender Disparity in Teaching Evaluations of Pediatric Faculty by Residents

OBJECTIVES

Despite their overrepresentation, female physicians continue to have lower rates of promotion compared with male physicians. Teaching evaluations play a role in physician advancement. Few studies have investigated gender disparity in resident evaluations of pediatric faculty. We hypothesized that gender disparities in resident evaluations of faculty exist and vary across subspecialties and primary work environments.

METHODS

Pediatric faculty institution-specific evaluations completed by residents from January 1, 2015, to March 9, 2020, were obtained from a single academic center. Mean ratings of faculty performance were compared by gender using a Wilcoxon 2-sample test.

RESULTS

Fifteen-thousand one-hundred and forty-two evaluations (5091 of male faculty and 10 051 of female faculty) were included. Female faculty were rated higher in overall teaching ability (female = 4.67 versus male = 4.65; P = .004). There was no statistical difference in the mean ratings of male and female faculty in the inpatient setting, whereas outpatient female faculty were rated higher in overall teaching ability (female = 4.79 versus male = 4.73; P = .005). For general pediatric faculty, females received higher ratings for overall teaching ability (female = 4.75 versus male = 4.70; P < .001). By contrast, there was no difference in ratings of subspecialty pediatric faculty.

CONCLUSIONS

Pediatric female faculty were statistically rated higher than male faculty in overall teaching ability, although these findings may not be educationally significant. The difference was driven by evaluations in the outpatient setting and for general pediatricians. This study is one of the first in pediatrics adding to the continued investigation of gender disparities in academic medicine.

Cognitive perspectives on maintaining physicians' medical expertise: V. Using a motivational framework to understand the benefits and costs of testing

We apply a motivational perspective to understand the implications of physicians' longitudinal assessment. We review the literature on situated expectancy-value theory, achievement goals, mindsets, anxiety, and stereotype threat in relation to testing and assessment. This review suggests several motivational benefits of testing as well as some potential challenges and costs posed by high-stakes, standardized tests. Many of the motivational benefits for testing can be understood from the equation of having the perceived benefits of the test outweigh the perceived costs of preparing for and taking the assessment. Attention to instructional framing, test purposes and values, and longitudinal assessment frameworks provide vehicles to further enhance motivational benefits and reduce potential costs of assessment.

Differences in Trainee Evaluations of Faculty by Rater and Ratee Gender

PURPOSE

To examine whether gender differences exist in medical trainees' (residents' and fellows') evaluations of faculty at a number of clinical departments.

METHOD

The authors conducted a single-institution (University of Minnesota Medical School) retrospective cohort analysis of 5,071 trainee evaluations of 447 faculty (for which trainee and faculty gender information was available) completed between July 1, 2019, and June 30, 2022. The authors developed and employed a 17-item measure of clinical teaching effectiveness, with 4 dimensions: overall teaching effectiveness, role modeling, facilitating knowledge acquisition, and teaching procedures. Using both between- and within-subject samples, they conducted analyses to examine gender differences among the trainees making ratings (rater effects), the faculty receiving ratings (ratee effects), and whether faculty ratings differed by trainee gender (interaction effects).

RESULTS

There was a statistically significant rater effect for the overall teaching effectiveness and facilitating knowledge acquisition dimensions (B = -0.28 and -0.14, 95% CI: [-0.35, -0.21] and [-0.20, -0.09], respectively, P < .001, medium corrected effect sizes between -0.34 and -0.54); female trainees rated male and female faculty lower than male trainees on both dimensions. There also was a statistically significant ratee effect for the overall teaching effectiveness and role modeling dimensions (B = -0.09 and -0.08, 95% CI: [-0.16, -0.02] and [-0.13, -0.04], P = .01 and < .001, respectively, small to medium corrected effect sizes between -0.16 and -0.44); female faculty were rated lower than male faculty on both dimensions. There was not a statistically significant interaction effect.

CONCLUSIONS

Female trainees rated faculty lower than male trainees and female faculty were rated lower than male faculty on 2 teaching dimensions each. The authors encourage researchers to continue to examine the reasons for the evaluation differences observed and how implicit bias interventions might help to address them.

How Do Academic Medicine Pathways Differ for Underrepresented Trainees and Physicians? A Critical Scoping Review

PURPOSE

Academic medicine faces difficulty recruiting and retaining a diverse workforce. The proportion of medical students who are underrepresented in medicine (URiM) is smaller than the proportion of URiM's in the general population, and these numbers worsen with each step up the academic medicine ladder. Previously known as the "leaky pipeline," this phenomenon may be better understood as disparate "pathways with potholes," which acknowledges the different structural barriers that URiM trainees and faculty face in academic medicine. This critical scoping review analyzed current literature to determine what variables contribute to the inequitable "pathways and potholes" URiM physicians experience in academic medicine.

METHOD

The authors combined scoping review methodology with a critical lens. The comprehensive search strategy used terms about academic medicine, underrepresented groups, and leaving academic medical careers. One reviewer conducted screening, full text review, and data extraction while in consultation with members of the research team. Data extraction focused on themes related to pathways and potholes, such as attrition, recruitment, and retention in academic medicine. Themes were iteratively merged, and quality of contribution to the field and literature gaps were noted.

RESULTS

Included papers clustered into attrition, recruitment, and retention. Those pertaining to attrition noted that URiM faculty are less likely to get promoted even when controlling for scholarly output, and a hostile work environment may exacerbate attrition. Recruitment and retention strategies were most effective when multi-pronged approaches changed every step of the recruitment and promotion processes.

CONCLUSIONS

These studies provide examples of various "potholes" that can affect representation in academic medicine of URiM trainees and faculty. However, only a few studies examined the link between isolating and hostile work environments, the so-called "chilly climate," and attrition from academic medicine. Understanding these concepts is key to producing the most effective interventions to improve diversity in medicine.

Veterinarian burnout demographics and organizational impacts: a narrative review

Burnout is a work-related syndrome of physical and emotional exhaustion secondary to prolonged, unresolvable occupational stress. Individuals of different demographic cohorts may have disparate experiences of workplace stressors and burnout impacts. Healthcare organizations are adversely affected by burnt out workers through decreased productivity, low morale, suboptimal teamwork, and potential impacts on the quality of patient care. In this second of two companion reviews, the demographics of veterinary burnout and the impacts of burnout on affected individuals and work environments are summarized, before discussing mitigation concepts and their extrapolation for targeted strategies within the veterinary workplace and profession.

Necessary but Insufficient and Possibly Counterproductive: The Complex Problem of Teaching Evaluations

The evaluation of clinical teachers' performance has long been a subject of research and debate, yet teaching evaluations (TEs) by students remain problematic. Despite their intuitive appeal, there is little evidence that TEs are associated with students' learning in the classroom or clinical setting. TEs are also subject to many forms of bias and are confounded by construct-irrelevant factors, such as the teacher's physical attractiveness or personality. Yet they are used almost exclusively as evaluations of and feedback to teachers. In this commentary, the authors review the literature on what TEs are meant to do, what they actually do in the real world, and their overall impact. The authors also consider productive ways forward. While TEs are certainly necessary to provide the crucial student voice, they are insufficient as the sole way to assess teachers. Further, they are often counterproductive. TEs carry so much weight for faculty that they can act as a disincentive for teachers to challenge learners and provide them with the critical feedback they often need, lest students give them poor ratings. To address these challenges, changes are needed, including embedding TEs in a programmatic assessment framework. For example, TEs might be used for formative feedback only, while other sources of data, such as peer assessments, learning outcomes, 360-degree feedback, and teacher reflections, could be collated into a portfolio to provide a more meaningful evaluation for teachers. Robust, transparent systems should be in place that dictate how TE data are used and to ensure they are not misused. Clinical teachers who do not "fail to fail" learners but instead take the time and effort to identify and support learners in difficulty should be recognized and rewarded. Learners need this support to succeed and the obligation to protect patients demands it.

A Glass Ceiling in Orthopedic Surgery: Publication Trends by Gender

Women are underrepresented across the field of orthopedic surgery and may face barriers to academic advancement. Research presentation at national meetings and publication record are important drivers of advancement in academic orthopedic surgery. However, little is known regarding potential gender differences in publication after orthopedic conference research presentation. This investigation analyzed research presentations at the Annual Meeting of the American Academy of Orthopaedic Surgeons in 2016 and 2017. Author gender was determined through a search of institutional and professional networking websites for gender-specific pronouns. Resulting publications were identified using a systematic search of PubMed and Google Scholar databases. A total of 1696 of 1803 (94.1%) abstracts from 2016 to 2017 had identifiable gender for both the first and last authors, with 1213 (71.5%) abstracts ultimately being published. There were no differences in average sample size or level of evidence between genders. Abstracts authored by women were significantly less likely to lead to publication compared with those by men (67.1% vs 72.1%, P=.023), with articles authored by women having a longer median time to publication (median, 20 months [interquartile range, 19] vs 17 months [interquartile range, 15]; P=.003). This discrepancy was most apparent in adult reconstruction, with women having a 15.5% lower rate of publication (55.1% [27/49] vs 70.6% [307/435]; P=.026) and lower publication journal impact factor (2.7±1.4 vs 3.4±3.4, P=.040) than men. Potential reasons for these discrepancies, including disproportionate domestic obligations, inadequate mentorship, and bias against female researchers, should be addressed. [Orthopedics. 2023;46(2):e118-e124.].

Gender Bias in Risk Management Reports Involving Physicians in Training - A Retrospective Qualitative Study

OBJECTIVE

Gender bias, which contributes to burnout and attrition of female medical trainees, may manifest as disparate workplace evaluations. Here, we explore gender-based differences in perceived competence and professionalism as described in an institutional electronic risk management reporting system.

DESIGN

In this retrospective qualitative study, recurring themes were identified from anonymous entries reported to an electronic institutional risk management database from July 2014 to July 2015, and from July 2019 to July 2020 using inductive methods. This electronic system is often used by hospital staff to document complaints against physicians under the pretext of poor patient care, regardless of whether an adverse event occurred. Two individuals independently coded entries. Themes were determined from event indicator codes (EIC) using Delphi methodology and compared between gender and specialty using bivariate statistics.

SETTING

A multi-center integrated healthcare delivery system.

PARTICIPANTS

Risk management entries pertaining to physician trainees by hospital staff as written submissions to the institution's electronic risk management reporting system. Main outcomes included themes defined as: (1) lack of professionalism (i.e., delay in response, attitude, lack of communication), (2) perceived medical error, (3) breach of institutional protocol.

RESULTS

Of the 207 entries included for analysis, 52 entries identified men (25%) and 31 entries identified women (15%). The gender was not available in 124 entries and, therefore, categorized as ambiguous. The most common complaint about men involved a physician-related EIC (n = 12, 23%, EIC TX39) and the most common complaint about women involved a communication-related EIC (n = 7, 23%, EIC TX55). Eighty-eight (43%) entries involved medical trainees; 82 (40%) involved surgical trainees. Women were more often identified by their name only (n = 8, 26% vs. n = 3, 6%; p < 0.001). This finding was consistent in both medical (n = 0, 0% vs. n = 5, 31%; p < 0.001) and surgical (n = 2, 7% vs. n = 3, 25%; p = 0.006) specialties. In entries involving women, a lack of professionalism was most frequently cited (n = 29, 94%). Entries identifying medical errors more frequently involved men (n = 25, 48% vs. n = 7, 23%; p = 0.02).

CONCLUSIONS

Gender-based differences exist in how hospital staff interpret trainees' actions and attitudes. These differences have consequences for training paradigms, perceptions of clinical competence, physician burnout, and ultimately, patient outcomes.

Specialty Gender Composition and Prevalence of Physician Harassment

Background: Women physicians remain a minority in most medical specialties and are at higher risk of workplace harassment than men. This research examines the relationship between a medical specialty's gender composition and physicians' workplace harassment experience. Materials and Methods: We used the Association of American Medical Colleges' National Sample Survey of Physicians 2019 (n = 6000). Participants self-reported harassment experiences in the 12 months preceding the survey, including threats of physical harm, physical harm, offensive and sexist remarks, and unwanted sexual advances from patients and coworkers. We used data from the American Medical Association to determine medical specialties' gender composition. We used multiple logistic regression to assess the relationship between harassment experiences and specialty gender composition. Results: Women and men physicians reported threats and harm at similar rates. However, women reported offensive, sexist remarks and unwanted sexual advances more frequently. We found greater representation of women within a specialty is associated with a lower prevalence of harassment experienced by men and women physicians (e.g., threats of physical harm, odds ratio [OR] = 0.973 [women] and 0.984 [men], and unwanted sexual advances, OR = 0.976 [women] and 0.981 [men]). Also, as women's representation in a specialty increases, the gender gap in experiences of most types of harassment decreases. Conclusions: Greater representation of women within a medical specialty is associated with a safer environment for both men and women physicians and narrower gender gaps in harassment experience. Our findings support efforts to increase gender diversity across the specialties and illuminate the dire need for antiharassment solutions in specialties with low women's representation.

Faculty diversity, equity, and inclusion in academic dentistry: Revisiting the past and analyzing the present to create the future

AIM

In 2021, NIDCR published the landmark report "Oral Health in America." It described that while oral health-related research and care has seen amazing progress, oral health inequities and lack of oral care for large segments of the US population have not improved. This situation plus the predicted increase of the diversification of the US population requires decisive actions to ensure that future dentists will be optimally prepared to provide the best possible care for all patients. A diverse dental educator workforce plays a crucial role in obtaining this goal. The objectives of this document were threefold. Aim 1 was to analyze past and current trends in the diversity and inclusion of historically underrepresented ethnic/racial (HURE) and marginalized (HURM) dental faculty members. Aim 2 focused on reviewing best practices and challenges related to achieving dental faculty and leadership diversity and inclusion. Aim 3 was to develop recommendations for increasing the diversity and inclusion of dental faculty in the present and future.

METHODS

An analysis of ethnicity/race and gender faculty data collected by the American Dental Education Association (ADEA) in 2011-2012 and 2018-2019 showed that achieving faculty diversity and inclusion has been an ongoing challenge, with limited success for faculty from HURE backgrounds. In order to create this much-needed change, best practices to increase the applicant pool, change recruitment strategies, and develop solid retention and promotion efforts were described. Research discussing the challenges to creating such changes was analyzed, and strategies for interventions were discussed.

CONCLUSION

In conclusion, evaluations of efforts designed to create a more diverse and inclusive work force is crucial. Institutions must evaluate their diversity data, practices utilized, and the policies implemented to determine whether the desired outcomes are achieved. Only then will the future dental workforce be optimally prepared to provide the best possible care for all patients in the United States.

Gender Difference in Teaching Evaluation Scores of Pediatric Faculty

OBJECTIVE

To evaluate associations between faculty gender and milestone-based teaching assessment scores assigned by residents.

METHODS

We performed a retrospective cohort study of milestone-based clinical teaching assessments of pediatric faculty completed by pediatric residents at a mid-sized residency program from July 2016 to June 2019. Assessments included 3 domains (Clinical Interactions, Teaching Skills, Role Modeling/Professionalism) comprised of a total of 11 sub-competency items. We used multilevel logistic regression accounting for repeat measures and clustering to evaluate associations between faculty gender and assessment scores in the 1) top quartile, 2) bottom quartile, or 3) top-box (highest score). Findings were adjusted for faculty rank and academic track, and resident year and gender.

RESULTS

Over 3 years, 2889 assessments of 104 faculty were performed by 91 residents. Between assessments of women and men faculty, there were no significant differences in the odds of receiving a score in the top quartile for the 3 domains (Clinical aOR 0.99, P = .86; Teaching aOR 0.99, P = .93; Role Modeling aOR 0.87, P = .089). However, assessments of women were more likely to receive a score in the bottom quartile in both Teaching (aOR 1.23, P = .019) and Role Modeling (aOR 1.26, P = .008). Assessments of women also had lower odds of receiving the highest score in 6 of 11 sub-competencies.

CONCLUSION

Results suggest that gender bias may play a role in resident assessments of pediatric faculty. Future studies are needed to determine if findings are replicated in other settings and to identify opportunities to reduce the gender gap in pediatric academic medicine.

Role of faculty characteristics in failing to fail in clinical clerkships

INTRODUCTION

In the context of competency-based medical education, poor student performance must be accurately documented to allow learners to improve and to protect the public. However, faculty may be reluctant to provide evaluations that could be perceived as negative, and clerkship directors report that some students pass who should have failed. Student perception of faculty may be considered in faculty promotion, teaching awards, and leadership positions. Therefore, faculty of lower academic rank may perceive themselves to be more vulnerable and, therefore, be less likely to document poor student performance. This study investigated faculty characteristics associated with low performance evaluations (LPEs).

METHOD

The authors analysed individual faculty evaluations of medical students who completed the third-year clerkships over 15 years using a generalised mixed regression model to assess the association of evaluator academic rank with likelihood of an LPE. Other available factors related to experience or academic vulnerability were incorporated including faculty age, race, ethnicity, and gender.

RESULTS

The authors identified 50 120 evaluations by 585 faculty on 3447 students between January 2007 and April 2021. Faculty were more likely to give LPEs at the midpoint (4.9%), compared with the final (1.6%), evaluation (odds ratio [OR] = 4.004, 95% confidence interval [CI] [3.59, 4.53]; p < 0.001). The likelihood of LPE decreased significantly during the 15-year study period (OR = 0.94 [0.90, 0.97]; p < 0.01). Full professors were significantly more likely to give an LPE than assistant professors (OR = 1.62 [1.08, 2.43]; p = 0.02). Women were more likely to give LPEs than men (OR = 1.88 [1.37, 2.58]; p 0.01). Other faculty characteristics including race and experience were not associated with LPE.

CONCLUSIONS

The number of LPEs decreased over time, and senior faculty were more likely to document poor medical student performance compared with assistant professors.

Assessment of Bias in Patient Safety Reporting Systems Categorized by Physician Gender, Race and Ethnicity, and Faculty Rank: A Qualitative Study

IMPORTANCE

Patient safety reporting systems (PSRSs) are designed to decrease the risk of harm to patients due to medical errors. Owing to the voluntary nature of PSRSs, implicit bias of the reporter may affect the management of safety events reported. Stanford Alert For Events (SAFE) is the PSRS used at Stanford Health Care.

OBJECTIVE

To examine whether variation exists in the content of SAFE reports based on demographic characteristics of physicians who are the subject of the event report.

DESIGN, SETTING, AND PARTICIPANTS

This retrospective qualitative analysis from a single academic medical center evaluated SAFE reports from March 2011 to February 2020. Event reports were coded by theme and categorized by severity (scale of 1 to 3, with 1 being the lowest and 3 the highest). The reports were then analyzed from October 2020 to February 2022 and categorized by physician gender, race and ethnicity, and faculty rank. A total of 501 patient safety events were collected from the adult hospital during the study period, and 100 were excluded owing to incompleteness of information.

MAIN OUTCOMES AND MEASURES

This qualitative study had no planned outcome.

RESULTS

A qualitative analysis was performed on 401 reports representing 187 physicians (138 [73.8%] male and 49 [26.2%] female). In terms of race and ethnicity, 4 physicians (2.1%) were African American, 49 (26.2%) were Asian; 7 (3.7%), Hispanic or Latinx; 108 (57.7%), White; and 19 (10.2%), declined to state. Female physicians had disproportionate representation among reports referencing communication and conversational issues and the lowest severity level. Male physicians had disproportionate representation for ignoring or omitting procedures, process issues, and physical intimidation. African American physicians had disproportionate representation for lack of communication and process issues. Asian physicians had disproportionate representation for lack of communication, process issues, conversational conduct, and the lowest severity level. Latinx physicians had disproportionate representation for conversational conduct. White physicians had disproportionate representation for ignoring or omitting procedures, verbal abuse, physical intimidation, and the highest severity level.

CONCLUSIONS AND RELEVANCE

In this qualitative study, female physicians and physicians who were members of racial and ethnic minority groups were more likely to be reported for low-severity communication issues compared with their male and White counterparts, respectively. These findings suggest that there may be a lower threshold for reporting events when the subject of the report is female and/or a member of a racial or ethnic minority group. Restructuring the reporting and management of patient safety events may be needed to facilitate conflict resolution in a manner that reduces implicit bias and fosters team cohesion.

Words Matter: Examining Gender Differences in the Language Used to Evaluate Pediatrics Residents

BACKGROUND

Gender disparities in academic medicine continue to be pervasive. Written evaluations of residents may provide insight into perceptions of residents by faculty, which may influence letters of recommendation for positions beyond residency and reinforce perceived stereotype threat experienced by trainees.

OBJECTIVE

To examine language used in faculty evaluations of pediatrics residents to determine if there are differences in language used with respect to gender of resident.

DESIGN/METHODS

All faculty evaluations of residents in 3 consecutive intern classes from 2016 to 2018 were collected and redacted for name and gender identifiers. We performed a qualitative analysis of written comments in 2 mandatory free text sections. The study team initially coded text collectively, generating a code book, then individually to apply the coding scheme. Next, evaluations were unblinded to gender. Code applications were aggregated by resident, and frequencies of code application by resident were compared by standardized mean differences to detect imbalances between genders.

RESULTS

A total of 448 evaluations were analyzed: 88 evaluations of 17 male residents, and 360 evaluations of 70 female residents. Codes more frequently applied to women included "enthusiasm," and "caring," while codes more frequently applied to men included "intelligence," and "prepared." A conceptual model was created to reflect potential impacts of these differences using a lens of social role theory.

CONCLUSIONS

We identified differences in the way male and female residents are evaluated by faculty, which may have negative downstream effects on female residents, who may experience negative self-perception, differential development of clinical skills, and divergent career opportunities as a result.

Beyond the ratings: gender effects in written comments from clinical teaching assessments

Assessment of clinical teachers by learners is problematic. Construct-irrelevant factors influence ratings, and women teachers often receive lower ratings than men. However, most studies focus only on numeric scores. Therefore, the authors analyzed written comments on 4032 teacher assessments, representing 282 women and 448 men teachers in one Department of Medicine, to explore for gender differences. NVivo was used to search for 61 evidence- and theoretically-based terms purported to reflect teaching excellence, which were analyzed using 2 × 2 chi-squared tests. The Linguistic Index and Word Count (LIWC) was used to categorize comment data, which were analyzed using linear regressions. The only significant difference in NVivo was that men were more likely than women to have the word "available" in a comment (OR 1.4, p < .05). A subset of LIWC variables showed significant gender differences, but all effects were modest. Men teachers had more positive emotion words written about them, while negative emotion words appeared equally. Significant differences occurred more often between the men and women residents who wrote the comments, rather than those attributed to the gender of the teachers. For example, women residents used more social and gender-related words (β 1.87, p < 0.001) and fewer words related to power or achievement (β -3.78, p < 0.001) than men residents. Profound gender differences were not found in teacher assessment comments in this large, diverse academic department of medicine, which differs from other studies. The authors explore possible reasons including differences in departmental culture and issues related to the methods used.

Hegemonic masculinity: representation of women surgeons in leadership positions in Pakistan

PURPOSE

Surgery is predominantly a masculine profession worldwide and has largely excluded women in leadership positions. This paper aims to examine the representation of women surgeons in leadership positions in Pakistan.

DESIGN/METHODOLOGY/APPROACH

Data were drawn from larger qualitative research examining the experiences of women surgeons in Pakistani hospitals. The data comprises in-depth interviews with ten doctors working in the Rawalpindi and Islamabad cities. The participants were selected by using the purposive sampling method and data were analyzed using thematic analysis.

FINDINGS

This study included participants from diverse surgical specialties from different stages of their career with two having leadership experience. Based on participants' perspectives several factors are responsible for this exclusion of women in leadership positions. The most prominent among these were long working hours for surgical leaders, greater responsibilities assigned to leadership positions, gender stereotypes and work-family conflict. Due to masculine hegemony, women were considered less capable and they were expected to have masculine traits to work as successful leaders. Interestingly, some participants had internalized such stereotypes and showed a lack of interest and lack of capabilities for surgical leadership as evident from their narratives.

RESEARCH LIMITATIONS/IMPLICATIONS

The findings of this paper are drawn from the perspectives of ten women surgeons working in Islamabad and Rawalpindi cities of Pakistan who were selected using a convenient sampling method. Hence, the results cannot be generalized to the larger population of women surgeons working in other cities of the country. Nevertheless, this study is unique in the sense that it provides useful insight into the experiences of the women surgeons and their perspectives on surgical leadership in Pakistani hospitals. Academically, it contributes to the global debates on surgical leadership by providing empirical evidence from Pakistan.

ORIGINALITY/VALUE

This paper contributes to the larger debates on the under-representation of women in leadership positions in surgery by unveiling the experiences of female surgeons from Pakistan. It calls for the need for structural changes in health management and policy to accommodate women surgeons. Organizational efforts could minimize some hurdles and encourage more women to take on more formal leadership roles. The authors also call for an increasing number of women in surgery to pave the way for creating new leadership opportunities.

Discrimination Towards Women in Surgery: A Systematic Scoping Review

BACKGROUND

Over the past twenty years explicit gender bias towards women in surgery has been replaced by more subtle barriers, which represent indirect forms of discrimination and prevents equality.

OBJECTIVE

The aim of our scoping review is to summarize the different forms of discrimination towards women in surgery.

METHODS

The database search consisted of original studies regarding discrimination towards female surgeons.

RESULTS

Of 3,615 studies meeting research criteria, 63 were included. Of these articles, 11 (18%) were focused on gender-based discrimination, 14 (22%) on discrimination in authorship, research productivity and research funding, 21 (33%) on discrimination in academic surgery, 7 (11%) on discrimination in surgical leadership positions and 10 (16%) on discrimination during conferences and in surgical societies. The majority (n = 53, 84%) of the included studies were conducted in the U.S.A. According to our analysis, female surgeons experience discrimination from male colleagues, healthcare workers, but also from patients and trainees. Possible solutions may include acknowledgement of the problem, increased education of diversity and integration for the younger generations, mentorship, coaching and more active engagement by male and female partners to support women in the surgical field.

CONCLUSIONS

Gender-based discrimination toward women in the field of surgery has evolved over the past twenty years, from an explicit to a more subtle attitude. A work-environment where diversity and flexibility are valued would allow female surgeons to better realize their full potential.

Closing the Gap: Evaluation of Gender Disparities in Urology Resident Operative Autonomy and Performance

OBJECTIVE

Gender disparities have demonstrated influence on several areas of medical trainee academic performance and surgeon professional attainment. The impact of gender on perceived operative autonomy and performance of urology residents is not well understood. This single-institution pilot study explores this relationship by evaluating urology faculty and resident assessment of resident operative autonomy and performance using the Society for Improving Medical Professional Learning app.

DESIGN

Using Society for Improving Medical Professional Learning, trainees in a single urology residency program were assessed in operative cases on three scales (autonomy, performance, and case complexity). Intraoperative assessments were completed by both faculty and residents (self-evaluation). Respective evaluations were compared to explore differences in ratings by gender.

SETTING

University of Michigan Health, Ann Arbor, MI.

PARTICIPANTS

University of Michigan Urology Residents and Faculty.

RESULTS

A total of 516 evaluations were submitted from 18 urology residents and 20 urology faculty. Self-reported ratings among female and male residents did not differ significantly for autonomy (p = 0.20) or performance (p = 0.82). Female and male residents received overall similar autonomy ratings that were not significantly different from female faculty (p = 0.66) and male faculty (p = 0.81). For female residents, there was no significant difference in performance ratings by faculty gender (p = 0.20). This finding was consistent when the resident was male (p = 0.70).

CONCLUSIONS

At our institution, there is no overall gender-based difference in self-rated or faculty-rated operative autonomy or performance among urology trainees. Understanding relevant facets of institutional culture as well as educational strategies between faculty and residents may identify factors contributing to this outcome.

Gendered Expectations: the Impact of Gender, Evaluation Language, and Clinical Setting on Resident Trainee Assessment of Faculty Performance

BACKGROUND

Gender inequity is pervasive in academic medicine. Factors contributing to these gender disparities must be examined. A significant body of literature indicates men and women are assessed differently in teaching evaluations. However, limited data exist on how faculty gender affects resident evaluation of faculty performance based on the skill being assessed or the clinical practice settings in which the trainee-faculty interaction occurs.

OBJECTIVE

Evaluate for gender-based differences in the assessment of general internal medicine (GIM) faculty physicians by trainees in inpatient and outpatient settings.

DESIGN

Retrospective cohort study SUBJECTS: Inpatient and outpatient GIM faculty physicians in an Internal Medicine residency training program from July 1, 2015, to December 31, 2018.

MAIN MEASURES

Faculty scores on trainee teaching evaluations including overall teaching ability and Accreditation Council for Graduate Medical Education (ACGME) competencies (medical knowledge [MK], patient care [PC], professionalism [PROF], interpersonal and communication skills [ICS], practice-based learning and improvement [PBLI], and systems-based practice [SBP]) based on the institutional faculty assessment form.

KEY RESULTS

In total, 3581 evaluations by 445 trainees (55.1% men, 44.9% women) assessing 161 GIM faculty physicians (50.3% men, 49.7% women) were included. Male faculty were rated higher in overall teaching ability (male=4.69 vs. female=4.63, p=0.003) and in four of the six ACGME competencies (MK, PROF, PBLI, and SBP) based on our institutional evaluation form. In the inpatient setting, male faculty were rated more favorably for overall teaching (male = 4.70, female = 4.53, p=<0.001) and across all ACGME competencies. The only observed gender difference in the outpatient setting favored female faculty in PC (male = 4.65, female = 4.71, p=0.01).

CONCLUSIONS

Male and female GIM faculty performance was assessed differently by trainees. Gender-based differences were impacted by the setting of evaluation, with the greatest difference by gender noted in the inpatient setting.

Gender-Based Linguistic Analysis of Pediatric Clinical Faculty Evaluations

BACKGROUND

Gendered stereotypes are embedded in the culture of medicine. Women are stereotypically expected to act collaboratively and less assertively, while men are expected to act with authority and power. Whether gender-biased language is expressed in academic pediatric teaching evaluations is unknown.

OBJECTIVE

Determine whether stereotypic gender-based linguistic differences exist in resident evaluations of pediatric faculty.

METHODS

We performed a retrospective cross-sectional study of clinical faculty evaluations by pediatric residents in a single program from July 2016 to June 2019. Using Linguistic Inquiry and Word Count, responses to 2 open-ended questions were analyzed for stereotypic language. Categories were reported as a percent of total words written. Comparisons between gender groups were conducted using nonparametric Wilcoxon rank sum tests. Rates of word use within each category were analyzed using logistic regression where faculty and resident gender were included as predictor variables.

RESULTS

A total of 6436 free-text responses from 3218 unique evaluations were included. As hypothesized, evaluations of women faculty were less likely than those of men to include certain agentic language like power (odds ratio [OR] 0.9, P < .001) and insight (OR 0.9, P < .001), and research words (OR 0.6, P = .003). As expected, evaluations of women were more likely to include grindstone words, like "hardworking" (OR 1.2, P = .012). Contrary to our hypothesis, women received fewer teaching words like "mentor" (OR 0.9, P = .048) and communal words like "friendly" (OR 0.6, P = .001).

CONCLUSION

Certain stereotypic language was demonstrated in clinical teaching evaluations of pediatric faculty. These findings should be further examined to improve gender inequities in academic pediatrics.

Gender Differences in Entrustable Professional Activity Evaluations of General Surgery Residents

OBJECTIVE

To determine differences in entrustable professional activity (EPA) assessments between male and female general surgery residents.

SUMMARY BACKGROUND DATA

Evaluations play a critical role in career advancement for physicians. However, female physicians in training receive lower evaluations and underrate their own performance. Competency-based assessment frameworks, such as EPAs, may help address gender bias in surgery by linking evaluations to specific, observable behaviors.

METHODS

In this cohort study, EPA assessments were collected from July 2018 to May 2020. The effect of resident sex on EPA entrustment levels was analyzed using multiple linear and ordered logistic regressions. Narrative comments were analyzed using latent dirichlet allocation to identify topics correlated with resident sex.

RESULTS

Of the 2480 EPAs, 1230 EPAs were submitted by faculty and 1250 were submitted by residents. After controlling for confounding factors, faculty evaluations of residents were not impacted by resident sex (estimate = 0.09, P = 0.08). However, female residents rated themselves lower by 0.29 (on a 0-4 scale) compared to their male counterparts (P < 0.001). Within narrative assessments, topics associated with resident sex demonstrated that female residents focus on the "guidance" and "supervision" they received while performing an EPA, while male residents were more likely to report "independent" action.

CONCLUSIONS

Faculty assessments showed no difference in EPA levels between male and female residents. Female residents rate themselves lower by nearly an entire post graduate year (PGY) level compared to male residents. Latent dirichlet allocation -identified topics suggest this difference in self-assessment is related to differences in perception of autonomy.

Gendered Differences in Teaching Performance Evaluations of Obstetrics and Gynecology Residents

OBJECTIVE

Teaching performance evaluations are commonly used for career development and advancement. Due to possible gendered expectations, implicit or explicit bias may emerge in evaluations completed by learners. This study investigated how third-year medical students evaluated teaching performance of obstetrics and gynecology resident physicians based on resident gender.

SETTING

This study was conducted at the Medical College of Wisconsin in Milwaukee, Wisconsin.

DESIGN

This retrospective mixed methods study examined teaching performance evaluations of obstetrics and gynecology resident physicians from 2010 to 2018, completed by third-year medical students. A two-sample, two-sided t-test was used to compare numerical scores. Deductive content analysis of written comments focused on specific categories: positive or negative agentic or communal demeanors and characteristics, teaching skills, character and professionalism, leadership abilities, clinical skills and knowledge, and frequency of words and phrases used to describe residents.

SETTING

This study was conducted at the Medical College of Wisconsin in Milwaukee, Wisconsin.

RESULTS

Of 83 residents (71 females, 12 males), there was no statistical significance in the teaching performance evaluation scores between male and female residents (n = 10,753 total completed evaluations). Female residents had lower scores than male residents; males tended not to score below 4 (5-point response scale; 5 = outstanding). Of 3,813 written comments, male residents had more positive comments, with statistical significance in communal characteristics (71.4% male, 53.9% female, p = 0.01). Female residents received more negative comments, with statistical significance in communal characteristics (7.5% female, 2.8% male, p = 0.01). Frequency of words presented that male residents had more "standout" traits ("outstanding," "excellent," "exemplary"), "ability" terms ("intelligent," "bright," "talented," "smart"), and were often considered "fun," "funny," and "humorous." Female residents were described by "compassion" terms ("kind," "compassionate").

CONCLUSION

Student-completed teaching performance evaluations are a valuable assessment of teaching skills and influence department recognition, award distribution, fellowship and employment opportunities. This study found that medical students did evaluate female residents differently than male residents. Understanding gendered expectations may assist in findings ways to address discrepancies between male and female physician evaluations.

Demographic and professional profile of Brazilian women in vascular surgery: final results

Background

Gender diversity in health teams is associated with better productivity. As women’s participation in surgery has been growing, it is important to improve knowledge about the elements that guide their professional development.

Objectives

The aim of this study was to outline the demographic and professional features of female vascular surgeons in Brazil.

Methods

A cross-sectional study was designed, in which a questionnaire was made available online for 60 days. Invitations to participate were distributed by institutional e-mail sent from the Brazilian Society of Angiology and Vascular Surgery (SBACV) to associate women surgeons. Results are presented as numbers and percentages. Odds ratios and chi-square tests were used for analysis.

Results

From a total of 810 invitations sent out, 281 questionnaires were completed. The most prevalent age groups were 25-35 years (n = 115) and 36-45 years (n = 114). Among those who worked exclusively in the private sector, 79.8% had at least one board certification (OR: 0.76, 95% CI: 0.65-0.89; p = 0.001). Regarding workload distribution, 64.4% and 34.2% reported that they spend more time in the clinic and hospital, respectively. Respondents with more years of experience reported a predominance of office practice (p = 0.002). Although 67.3% (n = 189) had published scientific papers, 68% (n = 191) had never held leadership roles.

Conclusions

The study respondents consisted of highly qualified women surgeons with respect to training, certification, and scientific engagement, but they remain underrepresented in professional management positions. Surgical societies and health institutions should act to promote inclusive and diverse leadership.

Female Residents Give Themselves Lower Scores Than Male Colleagues and Faculty Evaluators on ACGME Milestones

OBJECTIVE

Orthopedic surgery is one of the specialties with the lowest number of women residents and practicing surgeons. The gender discrepancy in orthopedic residency training may drive a competency bias. We asked whether female orthopedic surgery residents score themselves lower on the Accreditation Council for Graduate Medical Education (ACGME) Milestones than their male counterparts, and lower than their faculty evaluators.

DESIGN

We conducted a retrospective review of ACGME Milestone data from faculty and residents over a 4-year period. The data were analyzed using a snapshot of PGY2 (n = 20 residents) and PGY4 (n = 19 residents) scores, and using a Generalized Estimation Equation (GEE) to account for additional data points from the same residents over the 4-year data collection period.

SETTING

Assessment scores were compiled from a single orthopedic surgery residency at Oregon Health & Science University from 2014 to 2017.

PARTICIPANTS

The residency program has 5 residents in each program year (PGY1 through PGY5); a total of 25 residents during each year of the study were included.

RESULTS

On average, female residents scored themselves lower than both their male counterparts and their faculty mentors. Female PGY2 self-evaluation scores were lower than males in both patient care (p = 0.005) and medical knowledge (p < 0.001). When the GEE model was applied to 99 responses from 41 residents over a 4-year period, there were no gender-related differences in resident self-evaluation scores and in faculty scores of male and female residents, with the exception of meniscal tear. For this milestone, faculty rated female residents lower than males. Furthermore, the differences between faculty evaluation scores and resident self-evaluation scores were significantly lower for males than for females for 4 of the clinical domains, as well as the systems-based practice domains of cost and communication.

CONCLUSIONS

Our results indicate female residents are at risk for a competency bias during training, as reflected by evaluations using the ACGME Milestones.

Closing the gap: Increasing female representation in surgical leadership

BACKGROUND

Female medical students outnumber males with increasing representation in the workforce. However, women remain underrepresented in surgical leadership. Suggested reasons for this discrepancy are lack of female role models, mentorship, and gender discrimination. Thus, we set out to examine the change in leadership over time in our Department.

METHODS

Leadership data was gathered from a Department of Surgery in 2016 and 2020. Demographics including gender, age, and leadership position were compared using chi-squared testing.

RESULTS

Female representation in leadership roles increased from 2016 to 2020 at each professor rank(professor 0-100%, p < .001; associate professor 25-90%, p < .001, and assistant professor 7-71%, p < .001). In 2020, there were more female faculty(19.8 vs 26.4%, p = .270).

CONCLUSIONS

Female leadership in the Department has increased since 2016. Promoting females to leadership roles provides role models for upcoming female surgeons. Resources should be allocated to promote gender equity in surgical leadership.

Gender-Based Microaggressions in Surgery: A Scoping Review of the Global Literature

BACKGROUND

In addition to systemic gender disparities, women in surgery encounter interpersonal microaggressions. The objective of this study is to describe the most common forms of microaggressions reported by women in surgery.

METHODS

We conducted a scoping review using PubMed/MEDLINE, Ovid, and Web of Science to describe the international, indexed English-language literature on gender-based microaggressions experienced by female surgeons, surgical trainees, and medical students in surgery. After screening by title, abstract, and full-text, 37 articles were retained for data extraction and analysis. Microaggressions were analyzed using the Sexist Microaggression Experience and Stress Scale (MESS) framework and stratified by country of origin.

RESULTS

Gender-based microaggression publications most commonly originated from the United States (n = 27 articles), Canada (n = 3), and India (n = 2). Gender-based microaggressions were classified into environmental invalidations (n = 20), being treated like a second-class citizen (n = 18), assumptions of traditional gender roles (n = 12), sexual objectification (n = 11), assumptions of inferiority (n = 10), being forced to leave gender at the door (n = 8), and experiencing sexist language (n = 6). Additionally, attendings were more frequently reported to experience microaggressions than surgical trainees and medical students, but more articles reported data on attendings (n = 16) than surgical trainees (n = 10) or students (n = 4).

CONCLUSION

While recent advancements have opened the field of surgery to women, there is still a lack of female representation, and persistent microaggressions may perpetuate this gender disparity. Addressing microaggressions against female surgeons is essential to achieving gender equity in surgical practice.

Comparison of Performance Score for Female and Male Residents in General Surgery Doing Supervised Real-Life Laparoscopic Appendectomy: Is There a Norse Shield-Maiden Effect?

BACKGROUND

Gender bias may represent a threat to resident assessment during surgical training, and there have been concerns that women might be disadvantaged. There is a lack of studies investigating gender differences in 'entry-level' real-life procedures, such as laparoscopic appendectomy. We aimed to explore potential gender disparities in self-evaluation and faculty evaluation of a basic surgical procedure performed by junior surgical residents in general surgery.

METHODS

A structured training program in laparoscopic appendectomy was implemented before undertaking evaluation of real-life consecutive laparoscopic appendectomies by junior residents in general surgery. Resident and faculty gender-pairs were assessed. Intraclass correlation coefficient (ICC) was calculated using a single-rater, consistency, 2-way mixed-effects model.

RESULTS

A total of 165 paired sessions were completed to evaluate resident-faculty scores for the procedure. Overall, 19 residents participated (43% women) and 26 faculty (42% women) were involved. The overall correlation between faculty and residents was good (ICC > 0.8). The female-female pairs scored higher for most steps, achieving excellent (ICC ≥ 0.9) for several steps and for overall performance. Female residents were more likely to give a higher self-evaluated score on own performance particularly if evaluated by a female faculty. Also, female trainees had highest correlation-score with male faculty.

CONCLUSIONS

This study found higher performance scores in female surgical residents evaluated during real-time laparoscopic appendectomy. No negative gender bias toward women was demonstrated. Better insight into the dynamics of gender-based interaction and dynamics in both training, feedback and influence on evaluation during training is needed when evaluating surgical training programs.

The impact of a physician's recommendation and gender on informed decision making: A randomized controlled study in a simulated decision situation

Objective

This study examined the influence of physicians’ recommendations and gender on the decision‐making process in a preference‐sensitive situation.

Methods

N = 201 participants were put in a hypothetical scenario in which they suffered from a rupture of the anterior cruciate ligament (ACL). They received general information on two equally successful treatment options for this injury (surgery vs physiotherapy) and answered questions regarding their treatment preference, certainty and satisfaction regarding their decision and attitude towards the treatment options. Then, participants watched a video that differed regarding physician's recommendation (surgery vs physiotherapy) and physician's gender (female vs male voice and picture). Afterwards, they indicated again their treatment preference, certainty, satisfaction and attitude, as well as the physician's professional and social competence.

Results

Participants changed their treatment preferences in the direction of the physician's recommendation (P < .001). Decision certainty (P < .001) and satisfaction (P < .001) increased more strongly if the physician's recommendation was congruent with the participant's prior attitude than if the recommendation was contrary to the participant's prior attitude. Finally, participants’ attitudes towards the recommended treatment became more positive (surgery recommendation: P < .001; physiotherapy recommendation: P < .001). We found no influence of the physician's gender on participants’ decisions, attitudes, or competence assessments.

Conclusion

This research indicates that physicians should be careful with recommendations when aiming for shared decisions, as they might influence patients even if the patients have been made aware that they should take their personal preferences into account. This could be particularly problematic if the recommendation is not in line with the patient's preferences.

Gender Effects in Assessment of Clinical Teaching: Does Concordance Matter?

BACKGROUND

Gender bias is thought to exist in the assessment of clinical teachers, yet its extent in different specialties is not well-documented nor has it been studied at the individual-dyadic level.

OBJECTIVE

The authors sought to determine whether gender bias exists in residents' assessments of faculty teaching in 3 clinical departments, and if present, whether this is influenced by gender concordance or discordance between the faculty and resident.

METHODS

Residents' ratings of faculty in internal medicine (800 faculty, 5753 ratings), surgery (377, 2249), and family medicine (672, 3438) at the University of Toronto from 2016-2017 were analyzed using the overall global rating on a 5-point scale. A mixed-effects linear regression analysis accounted for nesting of ratings within each faculty member.

RESULTS

Overall scores of teaching effectiveness showed a strong skew to favorable ratings for all faculty and a ceiling effect. However, gender effects differed across departments. In internal medicine (38.5% female faculty), no significant gender effects were detected. In surgery (16.2% female) and family medicine (53.0% female), male faculty received significantly higher scores than female faculty. In surgery this was driven by male residents giving male faculty higher ratings (4.46 vs 4.26, P < .001). In family medicine this was driven by male faculty receiving higher ratings regardless of resident gender (4.65 to 4.57, P < .001).

CONCLUSIONS

Although effects were very small and inconsistent, with gender concordance mattering only for one department, it suggests that gender is a meaningful source of variance in teaching assessments.

The experiences of female surgeons around the world: a scoping review

INTRODUCTION

The Lancet Commission for Global Surgery identified an adequate surgical workforce as one indicator of surgical care accessibility. Many countries where women in surgery are underrepresented struggle to meet the recommended 20 surgeons per 100,000 population. We evaluated female surgeons' experiences globally to identify strategies to increase surgical capacity through women.

METHODS

Three database searches identified original studies examining female surgeon experiences. Countries were grouped using the World Bank income level and Global Gender Gap Index (GGGI).

RESULTS

Of 12,914 studies meeting search criteria, 139 studies were included and examined populations from 26 countries. Of the accepted studies, 132 (95%) included populations from high-income countries (HICs) and 125 (90%) exclusively examined populations from the upper 50% of GGGI ranked countries. Country income and GGGI ranking did not independently predict gender equity in surgery. Female surgeons in low GGGI HIC (Japan) were limited by familial support, while those in low income, but high GGGI countries (Rwanda) were constrained by cultural attitudes about female education. Across all populations, lack of mentorship was seen as a career barrier. HIC studies demonstrate that establishing a critical mass of women in surgery encourages female students to enter surgery. In HICs, trainee abilities are reported as equal between genders. Yet, HIC women experience discrimination from male co-workers, strain from pregnancy and childcare commitments, and may suffer more negative health consequences. Female surgeon abilities were seen as inferior in lower income countries, but more child rearing support led to fewer women delaying childbearing during training compared to North Americans and Europeans.

CONCLUSION

The relationship between country income and GGGI is complex and neither independently predict gender equity. Cultural norms between geographic regions influence the variability of female surgeons' experiences. More research is needed in lower income and low GGGI ranked countries to understand female surgeons' experiences and promote gender equity in increasing the number of surgical providers.

Women in surgery: a systematic review of 25 years

The number of women entering medicine significantly increased over the last decades. Currently, over half of the medical students are women but less than half are applying to surgery and even less go on to surgical specialties. Even fewer women are seen in leadership roles throughout the profession of surgery and surgical residency. Our purpose of the literature review is to identify any themes, which would provide insight to the current phenomenon. We used the Preferred Reporting Items for Systemic Reviews and Meta-Analyses method for a systematic review of the literature over a 20-year period (1998–2018). Five broad themes were identified: education and recruitment, career development, impact of/on life around the globe and surgical subspecialties as areas of barriers for women entering or considering surgery. The systematic review suggests there are opportunities to improve and encourage women entering the profession of surgery as well as the quality of life for surgeons. Creating systems for mentorship across programmes, having policies to support work–life balance and recognising surgical training overlaps with childbearing years are key opportunities for improvement. Improving the current status in surgery will require direction from leadership.

Investigating Association Between Sex and Faculty Teaching Evaluation in General Surgery Residency Programs: A Multi-Institutional Study

BACKGROUND

In specialties with gender imbalance, such as general surgery, women faculty frequently receive lower teaching evaluation scores compared with men, which can affect academic advancement.

STUDY DESIGN

We collected 1 year of anonymous resident-derived faculty teaching evaluations from 21 general surgery programs, along with resident, faculty, and department leadership gender complement. A composite evaluation score was calculated for each faculty. After accounting for within-program correlations, we compared male and female scores using the cluster-adjusted t-test to describe the respective mean differences with a 95% CI. Programs were divided into quartiles based on percent female faculty, female residents, and combined total females to detect associations between female representation and faculty teaching evaluation scores.

RESULTS

The 21 programs yielded 20,187 teaching evaluations of 1,177 faculty. Women comprised 28% of the faculty, 47% of residents, 43% of program directors, and 19% of department chairs. Overall, women faculty had significantly higher evaluation scores than men (90.6% vs 89.5%, p < 0.05). Female gender was associated with higher teaching evaluation scores compared with male faculty in the lowest quartiles for all combinations of women representation.

CONCLUSIONS

This multi-institutional analysis of general surgical resident evaluations of faculty identified that female gender was associated with higher evaluation scores than men (although the difference was small). This unanticipated finding might reflect the slowly changing gender balance within general surgery and attitudes towards female faculty in a traditionally male-dominated field. Contrary to our hypothesis, female gender was associated with higher faculty evaluation scores at programs with fewer women faculty and fewer women residents.

Gender differences in academic rank among faculty surgeons at US veterinary schools in 2019

OBJECTIVE

To describe academic rank, gender, surgical career length, and publication record of academic veterinary surgeons and to estimate the association between gender and higher academic rank.

STUDY DESIGN

Cross-sectional study.

SAMPLE

Residency-trained surgeons at US veterinary schools in 2019.

METHODS

Surgeons were identified via institutional websites. Data including surgeon gender, academic title, and year of board certification were collected from public resources. Publication record was measured by using author h-indices obtained from Scopus. Data were analyzed with descriptive and inferential statistics.

RESULTS

Three hundred eighteen surgeons were identified from 30 institutions, including 162 (51%) women and 156 (49%) men. Women represented 66% of instructors and assistant professors, and men represented 60% of associate and full professors. This distribution differed significantly (P < .001). Author h-index was associated with career length but not gender. Men were 2.5 times more likely than women to be associate or full professors (odds ratio 2.52, 95% CI 1.03-6.14, P = .042) after adjustment for career length and h-index.

CONCLUSION

Female surgery faculty at US veterinary schools in 2019 were concentrated in lower academic ranks and were less likely than male surgery faculty to be associate or full professors after adjustment for career length and publication record.

IMPACT

A gender gap exists in academic veterinary surgery in the United States. It is critical to recognize that women's increasing participation in veterinary medicine has not been matched by equal representation in all areas. Additional efforts are warranted to identify contributing factors and implement strategies to improve gender inclusion.

Service Provider Salience: When Guilt Undermines Consumer Willingness to Buy Time

Spending money on time-saving services can improve happiness and reduce stress. Yet many people do not spend money to save time even when they can afford to do so, potentially because they feel guilty about paying other people to complete disliked tasks on their behalf. Consistent with this proposition, we find evidence that individuals are most likely to experience guilt when outsourcing to a salient service provider. Across two large-scale surveys of working adults, including a nationally representative sample of employed Americans (Study 1a & 1b, N = 1,337), individuals reported greater guilt when they thought about outsourcing to a salient (vs. non-salient) service provider. Using a novel lab paradigm, participants felt greater guilt when the service provider was salient, which in turn undermined their willingness to buy time (Study 2, N = 350). In Study 3, these effects were mitigated by emphasizing the benefits of task completion for the service provider (N = 390). This research points to the potential of simple interventions to help organizations encourage individuals to make time-saving purchases.

Investigating Gender Differences in Faculty Evaluations by Trainees in a Gender-Balanced General Surgery Program

PURPOSE

Women account for 21% of faculty positions in general surgery. In fields with lower female representation, female faculty receive lower evaluation scores by trainees compared to male faculty. At 42%, the female faculty representation in our general surgery department doubles the national average. We sought to determine if variations in faculty evaluations would be observed in a more gender-balanced general surgery program.

METHODS

Two years of faculty teaching evaluations by residents in a general surgery residency program were collected from the MedHub system. Total 3277 resident evaluations of 26 faculty members (11 female, 15 male) were analyzed. Seven areas (scored 1-7, with 1 = needs improvement and 7 = outstanding) were examined. Chi-square test was used to compare the percentage of male and female faculty members who scored a 6 or 7 in each category, and multivariate logistic regression analysis was used to determine the association of gender with the evaluation score, while adjusting for the number of encounters between the trainee and the faculty member.

RESULTS

There were no significant differences between male and female faculty in the "overall" evaluation score, nor in the "practice-based learning" and the "interpersonal and communication skills" categories. Female faculty had statistically significantly higher scores in "patient care", "professionalism," and "systems-based care" categories, whereas male faculty had higher evaluations in the "medical knowledge" category.

CONCLUSION

In a general surgery residency program with a relatively gender-balanced faculty, there was no gender difference in the "overall" evaluation of faculty by residents. However, there were gender differences in specific domains. These findings suggest that gender balance in teaching faculty may help eliminate previously observed teaching evaluation bias in the traditionally male dominated fields.

Achieving Gender and Social Equality: More Than Gender Parity Is Needed

In this Perspective, the authors review Association of American Medical Colleges data on gender parity and intersectionality, consider the literature on gender parity in academic medicine and the underlying gender norms that explain these statistics, and offer recommendations for moving past indicators of parity to achieve gender and social equality.Improvements in gender parity among medical school graduates have not translated to gender parity among practicing physicians or medical school faculty, particularly for racial/ethnic minorities. Further, gender parity does not correspond to gender equality, such that gender-based disparities in salaries and advancement persist. In addition, social norms related to traditional gender role expectations reinforce existing biases and lead to sexual harassment and discrimination against women in the workplace.Building on their analysis of existing data and the literature, the authors offer concrete recommendations to achieve gender equality in academic medicine that not only improve parity but also support policies and practices to address the norms that further bias and discrimination. These recommendations include the collection, monitoring, and open reporting of data on salaries as well as on sex and race/ethnicity; stronger policies related to family leave and sexual discrimination and harassment; and accountability structures to ensure that policies are enforced. While these efforts alone cannot eliminate gender inequalities, academic medicine should be at the forefront of creating a climate in medicine that is supportive of gender equality as part of their larger goal of promoting social equality.

Linguistic analysis of pediatric residency personal statements: gender differences

BACKGROUND

All US residency programs require applicants to submit personal statements. Prior studies showed gender differences in personal statement writing, which has implications for gender bias in the application process, but previous studies have not considered the dual influence of specialty-specific values on personal statement writing by applicants of each gender.

OBJECTIVE

To understand gender differences in pediatric residency personal statements.

METHODS

From 2017 to 2018, we performed linguistic analysis of personal statements written by interviewees at a mid-size US pediatrics residency during two prior academic years. We assessed writing tone, communal language, and agentic language. We performed t-tests to evaluate for gender differences, p < 0.05.

RESULTS

We analyzed personal statements from 85 male and 85 female interviewees. Average word count was 676 words. Personal statements demonstrated analytic writing style with authentic and positive emotional tone. We found no gender differences in communal language for social affiliation (p = 0.31), adjectives (p = 0.49), or orientation (p = 0.48), which deviates from typical gender norms for male language use. Males used agentic language of reward more frequently (p = 0.02).

CONCLUSIONS

Findings suggest that social language is valued in pediatrics, a predominantly female specialty, regardless of applicant gender. Use of reward language by males is consistent with previous findings. Future studies should evaluate gender differences in residency applications across specialties to advance understanding of the role gender plays in the application process.

Review of Cognitive Biases in ACGME Milestones Training Assessments in Post-graduate Medical Education Programs

The course of study for young physicians for post-graduate training is an exciting and life-changing opportunity, one that is filled with the relentless optimism of intellectual discovery and personal growth and development. The American Council for Graduate Medical Education (ACGME) is a non-profit private council that evaluates and accredits internship, residency, and fellowship programs. The role of the ACGME is to oversee curriculums, training environments, and specialty evaluation standards to ensure satisfactory competency leading to board eligibility and certification in the respected field of study. The ACGME has the monumental task of guiding educational standards that are designed to both protect the public welfare and further educational programs. Many educational standards are objective, such as quantitative performance on examinations, involvement in research, and involvement in systems development and quality improvement. However, key clinical performance measures are based on prior training and experience. Over the last several years, studies examining rates of abuse and discrimination during post-graduate medical training in both the United States and Canadian studies, which have reported alarmingly high rates of 50%. With the increasing utility and availability of social media, such issues have become more transparent to the public. A plethora of studies has been conducted, examining physician biases towards patients, practice changes, insurance company regulations, and evolving healthcare systems. However, a significant amount of evaluation is merited when examining individual institutional cultures and the educational environments that harbor them. We wish to examine the role of ever-evolving specialty-specific ACGME-instituted educational milestones in Internal Medicine and Opthalmology in the context of potential cognitive biases and their implementation within post-graduate training programs.