Department of Orthopaedics and Rehabilitation, School of Medicine, Oregon Health & Sciences University School of Medicine, Portland, Oregon.
University of California, Irvine, School of Medicine, Irvine, California.
J Surg Educ. 2021 Jul-Aug;78(4):1305-1311. doi: 10.1016/j.jsurg.2020.12.003. Epub 2020 Dec 19.
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.
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.
Assessment scores were compiled from a single orthopedic surgery residency at Oregon Health & Science University from 2014 to 2017.
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.
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.
Our results indicate female residents are at risk for a competency bias during training, as reflected by evaluations using the ACGME Milestones.
矫形外科是女性住院医师和执业外科医生人数最少的专业之一。矫形住院医师培训中的性别差异可能导致能力偏见。我们想知道女性矫形外科住院医师是否给自己在研究生医学教育认证委员会（ACGME）里程碑上的评分低于男性同行，也低于他们的教员评估者。
我们对 4 年来教员和住院医师的 ACGME 里程碑数据进行了回顾性分析。使用 PGY2（n=20 名住院医师）和 PGY4（n=19 名住院医师）的评分快照以及广义估计方程（GEE）来分析数据，以说明在 4 年数据收集期间来自同一住院医师的其他数据点。
评估分数是从俄勒冈健康与科学大学的一个单一矫形外科住院医师项目中汇编的，时间为 2014 年至 2017 年。
每个项目年度（PGY1 至 PGY5）的住院医师项目有 5 名住院医师；在研究的每一年都有 25 名住院医师参加。
平均而言，女性住院医师给自己的评分低于男性同行和教员。女性 PGY2 自我评估分数在患者护理（p=0.005）和医学知识（p<0.001）方面均低于男性。当将 GEE 模型应用于 4 年内 41 名住院医师的 99 次回复时，在住院医师自我评估分数以及男性和女性住院医师的教员评分方面，除半月板撕裂外，没有性别相关差异。在这个里程碑上，教员对女性住院医师的评价低于男性。此外，在 4 个临床领域以及系统为基础的实践领域（成本和沟通）中，男性教员评估分数和住院医师自我评估分数之间的差异明显低于女性。
我们的结果表明，女性住院医师在培训期间存在能力偏见的风险，这反映在使用 ACGME 里程碑进行的评估中。
