K.E. Hauer is professor, Department of Medicine, University of California, San Francisco, San Francisco, California; ORCID: https://orcid.org/0000-0002-8812-4045 .
D. Jurich is manager, psychometrics, National Board of Medical Examiners, Philadelphia, Pennsylvania.
Acad Med. 2021 Jun 1;96(6):876-884. doi: 10.1097/ACM.0000000000004040.
To examine whether there are group differences in milestone ratings submitted by program directors working with clinical competency committees (CCCs) based on gender for internal medicine (IM) residents and whether women and men rated similarly on milestones perform comparably on subsequent in-training and certification examinations.
This national retrospective study examined end-of-year medical knowledge (MK) and patient care (PC) milestone ratings and IM In-Training Examination (IM-ITE) and IM Certification Examination (IM-CE) scores for 2 cohorts (2014-2017, 2015-2018) of U.S. IM residents at ACGME-accredited programs. It included 20,098/21,440 (94%) residents, with 9,424 women (47%) and 10,674 men (53%). Descriptive statistics and differential prediction techniques using hierarchical linear models were performed.
For MK milestone ratings in PGY-1, men and women showed no statistical difference at a significance level of .01 (P = .02). In PGY-2 and PGY-3, men received statistically higher average MK ratings than women (P = .002 and P < .001, respectively). In contrast, men and women received equivalent average PC ratings in each PGY (P = .47, P = .72, and P = .80, for PGY-1, PGY-2, and PGY-3, respectively). Men slightly outperformed women with similar MK or PC ratings in PGY-1 and PGY-2 on the IM-ITE by about 1.7 and 1.5 percentage points, respectively, after adjusting for covariates. For PGY-3 ratings, women and men with similar milestone ratings performed equivalently on the IM-CE.
Milestone ratings were largely similar for women and men. Generally, women and men with similar MK or PC milestone ratings performed similarly on future examinations. Although there were small differences favoring men on earlier examinations, these differences disappeared by the final training year. It is questionable whether these small differences are educationally or clinically meaningful. The findings suggest fair, unbiased milestone ratings generated by program directors and CCCs assessing residents.
检查在以临床能力委员会（CCC）为基础的医学专业学术文献中，指导主任在提交里程碑式评分时是否存在基于性别的群体差异，以及女性和男性在里程碑式评分上的表现是否相似，是否在随后的培训和认证考试中表现相当。
本项全国性回顾性研究检查了美国医学专业学术文献中 2 个队列（2014-2017 年，2015-2018 年）的住院医师在年末的医学知识（MK）和患者护理（PC）里程碑式评分以及内科住院医师培训考试（IM-ITE）和内科医师认证考试（IM-CE）成绩。研究共纳入了 20948/21440（94%）名住院医师，其中女性 9424 名（47%），男性 10674 名（53%）。使用分层线性模型进行描述性统计和差异预测技术。
在 PGY-1 的 MK 里程碑式评分中，男性和女性在.01 的显著性水平上没有统计学差异（P =.02）。在 PGY-2 和 PGY-3，男性获得的平均 MK 评分明显高于女性（P =.002 和 P <.001）。相反，在每个 PGY 中，男性和女性获得的平均 PC 评分相当（PGY-1、PGY-2 和 PGY-3 的 P 值分别为.47、P =.72 和 P =.80）。在调整了协变量后，在 IM-ITE 中，在 PGY-1 和 PGY-2 中，具有相似的 MK 或 PC 评分的男性比女性分别高出约 1.7%和 1.5%，在 PGY-3 的评分中，具有相似里程碑式评分的女性和男性在 IM-CE 上的表现相当。
里程碑式评分在女性和男性中基本相似。一般来说，具有相似的 MK 或 PC 里程碑式评分的女性和男性在未来的考试中表现相似。尽管在早期考试中存在男性略有优势的小差异，但这些差异在最后一年的培训中消失了。这些小差异是否具有教育或临床意义是值得怀疑的。这些发现表明，指导主任和评估住院医师的 CCC 生成了公平、无偏见的里程碑式评分。
