University of Southern California: Los Angeles, Department of Sociology, Los Angeles, California.
University of British Columbia, Department of Sociology, Vancouver, British Columbia, Canada.
West J Emerg Med. 2023 Sep;24(5):847-854. doi: 10.5811/westjem.58153.
Prior research has demonstrated that men and women emergency medicine (EM) residents receive similar numerical evaluations at the beginning of residency, but that women receive significantly lower scores than men in their final year. To better understand the emergence of this gender gap in evaluations we examined discrepancies between numerical scores and the sentiment of attached textual comments. This multicenter, longitudinal, retrospective cohort study took place at four geographically diverse academic EM training programs across the United States from July 1, 2013-July 1, 2015 using a real-time, mobile-based, direct-observation evaluation tool. We used complementary quantitative and qualitative methods to analyze 11,845 combined numerical and textual evaluations made by 151 attending physicians (94 men and 57 women) during real-time, direct observations of 202 residents (135 men and 67 women). Numerical scores were more strongly positively correlated with positive sentiment of the textual comment for men (r = 0.38, P < 0.001) compared to women (r = -0.26, P < 0.04); more strongly negatively correlated with mixed (r = -0.39, P < 0.001) and negative (r = -0.46, P < 0.001) sentiment for men compared to women (r = -0.13, P < 0.28) for mixed sentiment (r = -0.22, P < 0.08) for negative; and women were around 11% more likely to receive positive comments alongside lower scores, and negative or mixed comments alongside higher scores. Additionally, on average, men received slightly more positive comments in postgraduate year (PGY)-3 than in PGY-1 and fewer mixed and negative comments, while women received fewer positive and negative comments in PGY-3 than PGY-1 and almost the same number of mixed comments. Women EM residents received more inconsistent evaluations than men EM residents at two levels: 1) inconsistency between numerical scores and sentiment of textual comments; and 2) inconsistency in the expected career trajectory of improvement over time. These findings reveal gender inequality in how attendings evaluate residents and suggest that attendings should be trained to provide all residents with feedback that is clear, consistent, and helpful, regardless of resident gender.
先前的研究表明，男性和女性急诊医学（EM）住院医师在住院初期的评分相似，但在住院的最后一年，女性的评分明显低于男性。为了更好地了解评估中这种性别差距的出现，我们检查了数值评分与附加文本评论的情绪之间的差异。这项多中心、纵向、回顾性队列研究于 2013 年 7 月 1 日至 2015 年 7 月 1 日在美国四个地理位置不同的学术 EM 培训项目中进行，使用实时、基于移动的直接观察评估工具。我们使用补充的定量和定性方法分析了 151 名主治医生（94 名男性和 57 名女性）在 202 名住院医师（135 名男性和 67 名女性）实时直接观察期间对 11845 份综合数值和文本评估的评价。对于男性，数值评分与文本评论的积极情绪呈更强的正相关（r=0.38，P<0.001），而对于女性，数值评分与文本评论的积极情绪呈更强的负相关（r=-0.26，P<0.04）；与混合（r=-0.39，P<0.001）和负面（r=-0.46，P<0.001）情绪的相关性更强对于男性来说，与女性（r=-0.13，P<0.28）相比，混合情绪（r=-0.22，P<0.08）的情绪和负面情绪；并且女性获得更高分数的可能性大约高出 11%，而获得更低分数的可能性更大，获得更高分数的可能性更大。此外，平均而言，男性在住院医师 3 年级（PGY-3）获得的积极评价略多于 PGY-1，而获得的混合和负面评价较少，而女性在 PGY-3 获得的积极和负面评价少于 PGY-1，而获得的混合评价几乎相同。女性急诊医学住院医师比男性住院医师在两个层面上获得更不一致的评估：1）数值评分与文本评论情绪之间的不一致；2）随着时间的推移，预期职业轨迹改善的不一致。这些发现揭示了主治医生评估住院医师方面的性别不平等，并表明主治医生应该接受培训，无论住院医师的性别如何，都应向所有住院医师提供明确、一致和有益的反馈。
