Department of Emergency Medicine, Penn Medicine, Philadelphia, Pennsylvania.
FOCUS on Health and Leadership for Women, Penn Medicine, Philadelphia, Pennsylvania.
JAMA Netw Open. 2022 Nov 1;5(11):e2243134. doi: 10.1001/jamanetworkopen.2022.43134.
Prior studies have revealed gender differences in the milestone and clinical competency committee assessment of emergency medicine (EM) residents.
To explore gender disparities and the reasons for such disparities in the narrative comments from EM attending physicians to EM residents.
DESIGN, SETTING, AND PARTICIPANTS: This multicenter qualitative analysis examined 10 488 narrative comments among EM faculty and EM residents between 2015 to 2018 in 5 EM training programs in the US. Data were analyzed from 2019 to 2021.
Differences in narrative comments by gender and study site. Qualitative analysis included deidentification and iterative coding of the data set using an axial coding approach, with double coding of 20% of the comments at random to assess intercoder reliability (κ, 0.84). The authors reviewed the unmasked coded data set to identify emerging themes. Summary statistics were calculated for the number of narrative comments and their coded themes by gender and study site. χ2 tests were used to determine differences in the proportion of narrative comments by gender of faculty and resident.
In this study of 283 EM residents, of whom 113 (40%) identified as women, and 277 EM attending physicians, of whom 95 (34%) identified as women, there were notable gender differences in the content of the narrative comments from faculty to residents. Men faculty, compared with women faculty, were more likely to provide either nonspecific comments (115 of 182 [63.2%] vs 40 of 95 [42.1%]), or no comments (3387 of 10 496 [32.3%] vs 1169 of 4548 [25.7%]; P < .001) to men and women residents. Compared with men residents, more women residents were told that they were performing below level by men and women faculty (36 of 113 [31.9%] vs 43 of 170 [25.3%]), with the most common theme including lack of confidence with procedural skills.
In this qualitative study of narrative comments provided by EM attending physicians to residents, multiple modifiable contributors to gender disparities in assessment were identified, including the presence, content, and specificity of comments. Among women residents, procedural competency was associated with being conflated with procedural confidence. These findings can inform interventions to improve parity in assessment across graduate medical education.
先前的研究表明，在急诊医学（EM）住院医师的里程碑和临床能力委员会评估中存在性别差异。
探讨急诊医师对住院医师的叙述性评论中存在的性别差异及其原因。
设计、地点和参与者：这项多中心定性分析检查了 2015 年至 2018 年间美国 5 个 EM 培训项目中 EM 教师和 EM 住院医师之间的 10488 条叙述性评论。数据于 2019 年至 2021 年进行分析。
按性别和研究地点划分的叙述性评论差异。定性分析包括使用轴向编码方法对数据集进行去识别和迭代编码，随机对 20%的评论进行双编码，以评估编码者之间的可靠性（κ，0.84）。作者审查了未蒙面编码数据集，以确定新出现的主题。按性别和研究地点计算了叙述性评论的数量及其编码主题。使用 χ2 检验确定教师和住院医师中叙述性评论的比例差异。
在这项对 283 名 EM 住院医师（其中 113 名[40%]为女性）和 277 名 EM 主治医生（其中 95 名[34%]为女性）的研究中，教师对住院医师的叙述性评论内容存在显著的性别差异。与女性教师相比，男性教师更有可能提供非特定评论（182 名中的 115 名[63.2%]，而 95 名中的 40 名[42.1%]）或根本不发表评论（10496 名中的 3387 名[32.3%]，而 4548 名中的 1169 名[25.7%]；P<0.001）给男性和女性住院医师。与男性住院医师相比，更多的女性住院医师被告知，男性和女性教师认为他们的表现低于水平（113 名中的 36 名[31.9%]，而 170 名中的 43 名[25.3%]），最常见的主题包括对程序技能缺乏信心。
在这项对急诊医师向住院医师提供叙述性评论的定性研究中，确定了评估中性别差异的多个可修正的促成因素，包括评论的存在、内容和特异性。在女性住院医师中，程序能力与程序信心相混淆。这些发现可以为改善研究生医学教育中评估的平等提供信息。
