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Examining Differential Rater Functioning and Bias in the Holistic Review of Residency Applications Open PDF
(Journal of Graduate Medical Education, 2026-06)
Barnes, Leandra A.
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Sebok-Syer, Stefanie S.
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Wind, Stefanie A.
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Nord, Kristin M.
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Laidlaw, Kathrina
BACKGROUND: The impact of rater bias in applicant selection for residency interviews using holistic review is poorly understood. OBJECTIVE: To measure faculty raters' bias toward applicant gender and underrepresented in medicine (URiM) status in their recommendations to offer residency interviews. METHODS: In this cross-sectional study, applicant (n=3875) and faculty rater (n=69) data within a single institution's dermatology residency application database from 2014 to 2023 were examined for differences in rater judgments to interview applicants as measured by logits (ie, a standardized unit of scoring difference) using the many-facet Rasch model, a statistical method that accounts for variations among raters, applicants, and scoring for applicant gender (23% women, 14% men, and 63% unknown) and URiM status (26% White, 21% non-White non-URiM, 12% URiM, 41% unknown). RESULTS: Rater bias, as measured in logits using the rater severity measure, was minimal for applicant gender (-0.12, 0.08 logits) and URiM status (-0.07, 0.04 logits). However, raters were more lenient (ie, likely to favor an interview) when the applicant's and rater's gender (-1.74 logits, SE 0.05) or URiM status (-0.46 logits, SE 0.05) were concordant. Conversely, raters were more severe (ie, unlikely to favor an interview) when discordant on gender (1.74 logits, SE 0.05) or URiM status (0.46 logits, SE 0.05). More than 50% of individual raters exhibited substantial gender bias, and approximately 33% for URiM status bias when concordant. CONCLUSIONS: Raters were more likely to favor offering interview invitations to applicants with concordant gender or URiM status and less likely to favor interviewing applicants with discordant gender or URiM status.
Are there gender differences in academic medical career aspirations related to research, mentoring and discrimination? A national cross-sectional study of French medical residents Open PDF
(BMJ, 2026-05)
Deledalle, Aurore
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Congard, Anne
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Bour, Valentine
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Sarda, Élisa
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Cohen, Fleur
OBJECTIVES: Academic medical careers remain marked by persistent gender inequalities, despite the growing feminisation of the medical workforce. The objective of this study was to examine whether gender differences exist in key individual and institutional determinants of academic medical career aspirations among medical residents, including research motivation, mentoring, work centrality, self-efficacy, perceived discrimination and stress. DESIGN: This was a national cross-sectional online survey. SETTING: Multicentre study conducted across 36 medical schools in France. PARTICIPANTS: A total of 1570 medical residents (997 women and 573 men) voluntarily participated between November 2022 and February 2023. All participants completed validated self-report questionnaires. There were no exclusion criteria beyond being enrolled in a French residency programme. PRIMARY AND SECONDARY OUTCOME MEASURES: Attitudes towards research (interest, motivation, significance) were measured using the Scale of Attitudes towards Research. Mentoring was assessed with the Mentor-Mentee Perception Questionnaire, work centrality with Hirschfeld and Feild's scale, self-efficacy with the General Self-Efficacy Scale, perceived discrimination with the Sexual Harassment and Discrimination Experiences of Academic Medical Faculty instrument and stress with the Perceived Stress Scale. Gender differences were analysed using t-tests or χ² tests with Holm-Bonferroni corrections for multiple comparisons. RESULTS: Compared with men, women reported lower research motivation (mean (SD) 21.0 (5.5) vs 22.8 (5.5); padj=0.011), lower research interest (27.1 (5.5) vs 28.1 (5.7); padj=0.011), lower work centrality (26.7 (7.0) vs 28.2 (8.1); padj=0.011) and lower self-efficacy (28.3 (5.2) vs 29.9 (5.0); padj=0.011). Women were less likely to report having a mentor (38.5% vs 44.5%; padj=0.02). They also reported substantially higher levels of experienced gender discrimination (22.8% vs 3.8%; padj=0.005), sexual harassment (57.7% vs 18.2%; padj=0.005) and perceived stress (8.48 (3.29) vs 7.27 (3.43); padj=0.011) CONCLUSIONS: Gender differences were observed across several individual and institutional factors associated with academic medical career aspirations. Reduced access to mentoring and greater exposure to discrimination and stress among women may contribute to lower research motivation and self-efficacy. These findings highlight the need for institutional strategies addressing mentoring, workplace culture and equity to support gender parity in academic medicine.
Exploring gender disparities in academic orthopaedic surgery faculty: analyzing subspecialty and leadership diversity to foster inclusivity Open PDF
(Springer Science and Business Media LLC, 2025-07-11)
Anand, Malini
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Julian, Kaitlyn R.
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Mulcahey, Mary K.
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Wong, Stephanie E.
Background The historic gap in gender diversity within orthopaedic surgery is widely acknowledged and continues to persist. The lack of female representation in orthopaedic surgery has been attributed to a variety of factors, including the absence of female mentors and leaders within the field. As such, we sought to examine the gender diversity among orthopaedic surgery faculty in various subspecialties at academic institutions and the distribution of female faculty in positions of leadership. Methods The American Medical Association Fellowship and Residency Electronic Interactive Database (FREIDA) was used to identify all allopathic orthopaedic surgery residency programs during the 2022 to 2023 academic year. The total number of faculty, and distribution of female faculty by subspecialty were collected from January to March 2023. The mean and percentage of female faculty in each subspecialty per program was calculated. Results The total number of orthopaedic surgery female faculty identified was 524. The subspecialty with the highest percentage of female faculty per program was pediatrics at 26.1% (148/511). Hand (18.6%; 113/511), oncology (19.2%; 38/511), foot and ankle (13.6%; 49/511), spine (3.9%; 21/511), shoulder and elbow (7.4%; 7/511) and adult reconstruction (3.7%; 24/511) had lower percentages of female faculty per program. A total of 52 (10.2%) female section chiefs were identified across all programs. Oncology had the highest percentage of female faculty represented in section leadership at 18.4% (7) and sports medicine had the lowest at 4.8% (4). Conclusion Gender diversity of faculty in orthopaedic surgery is low with adult reconstruction (3.7%), spine (3.9%), and shoulder and elbow (7.4%) having the lowest percentages of female faculty. The percentage of female faculty represented in section leadership is also lacking with a total of 52 (10.2%) female section chiefs identified across all programs. Increasing the number of females in leadership positions across all orthopaedic subspecialties may be one step in helping improve gender diversity in the field.
Beyond the Scores: Gendered Interpretations of Emergency Medicine Resident Assessments of Interdependent Performances Open PDF
(Ubiquity Press, Ltd., 2025-08-21)
El Galad, Asil
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Sebok-Syer, Stefanie S.
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Panza, Michael
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Ng, Kristen
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Lingard, Lorelei
PURPOSE: In medicine, gender bias and gendered language within assessments of individual performance are well established. Recent shifts toward assessing interdependence (the ability to work supportively and collaboratively within teams) demand we understand how gender bias and gendered language influence assessments. In exploring how faculty assess residents' interdependent performances, this study evaluated how gender-presentation influences faculty raters' assessments of residents' interdependence in Emergency Medicine (EM). METHODS: Using a multiple-methods (an experimental within-subjects study with follow-up interviews), 18 EM faculty from Canada and the United States assessed scripted videos of identical clinical encounters acted by male- and female-presenting residents. Faculty assessed female residents via anonymous online surveys and, six months later, assessed male residents via follow-up interviews using the same clinical scenarios. After every clip, faculty completed entrustable professional activity (EPA) and Milestone ratings and provided narrative justifications. Statistical analyses were conducted using Wilcoxon signed-rank tests to assess gender differences in EPA and Milestone scores. Qualitative data were analyzed using thematic analysis to identify recurring, gendered patterns in narrative justifications. RESULTS: Quantitative results revealed no gender differences in Milestone and EPA scores, except for the resuscitation entrustment rating, where male residents were rated less favorably (z = -3.09, p = 0.002). Qualitative findings uncovered subtle gender differences. For the same clinical performances, male residents were frequently described as leaders, while female residents as collaborative. Furthermore, male residents' help-seeking was framed as proactive, whereas female residents' help-seeking was indicative of lacking knowledge. Finally, bias was not consistent across genders: male leadership expectations could negatively flavor assessments of male collaborative performances. CONCLUSION: EPA and Milestone scores showed marginal gender-based differences, while narrative justifications reflected clear gendered expectations about residents' interdependence. These findings highlight the need for equity-oriented assessment practices that interrogate both the numbers and the narratives. As team-based competencies like interdependence become central to clinical training, ensuring that assessments reflect fair, unbiased interpretations are essential to supporting all learners equitably.
Gender Disparity in Earliest Phase of Academic Surgical Training: An Area for Intervention Open PDF
(2023)
Zheng, H.
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Al-Refaie, W.
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Chou, J.
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Galli, F.
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Lai, V.
BACKGROUND: To overcome persistent gender disparities in academic surgery, it is critical to examine the earliest phase of surgical training. This national study sought to assess whether gender disparities also existed among surgical interns, as a proxy for medical school research experience in both quantity and quality. STUDY DESIGN: Using the 2021 to 2022 public information of 1,493 US-graduated categorical general surgery interns, a bibliometric evaluation was conducted to assess medical school research experience. Multivariable linear regressions with response log-transformed were performed to evaluate the impact of intern gender on (1) total number of peer-reviewed publications, (2) total impact factor (TIF), and (3) adjusted TIF based on authorship placement (aTIF). Back-transformed estimates were presented. RESULTS: Of these interns, 52.3% were female. Significant differences were observed in TIF (male 6.4 vs female 5.3, p = 0.029), aTIF (male 10.8 vs female 8.7, p = 0.035), gender concordance with senior authors (male 79.9% vs female 34.1%, p < 0.001), Hirsch index (male 21.0 vs female 18.0, p = 0.026), and the geographic region of their medical schools (p = 0.036). Multivariable linear regressions revealed that female interns were associated with lower TIF (0.858, p = 0.033) and aTIF (0.851, p = 0.044). Due to a significant gender-by-region interaction, adjusted pairwise comparisons showed that male interns in the Northeast had approximately 70% higher TIF (1.708, p = 0.003) and aTIF (1.697, p = 0.013) than female interns in the South. CONCLUSIONS: Gender disparities existed in the quality of research experience in the earliest phase of surgical training. These timely results call for additional interventions by the stakeholders of graduate medical education. Copyright © 2023 by the American College of Surgeons. Published by Wolters Kluwer Health, Inc. All rights reserved.
Gender Difference in Teaching Evaluation Scores of Pediatric Faculty Open PDF
(2023)
Tiedt, Kristin
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Webber, Sarah
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Babal, Jessica
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Nackers, Kirstin A. M.
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Allen, Ann
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.
How Well Represented Are Women Orthopaedic Surgeons and Residents on Major Orthopaedic Editorial Boards and Publications? Open PDF
(2020)
Rynecki, Nicole D.
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Krell, Ethan S.
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Potter, James S.
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Ranpura, Akash
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Beebe, Kathleen S.
BACKGROUND: Recent studies indicate that women are substantially underrepresented as orthopaedic surgeons and residents compared with other specialties in medicine and medical school. The reasons for this are multifactorial and not completely understood, but previous studies suggest that women may be attracted to fields in which they have female role models. Given that women interested in academia and research may use female editorship and authorship as a proxy for female representation in orthopaedic surgery, we wanted to examine the proportion of women represented in orthopaedic journals and determine if it reflects the distribution of women in orthopaedic surgery as a field. We further wanted to understand if this representation has changed over time in the setting of a slowly shifting gender landscape within orthopaedic surgery. QUESTIONS/PURPOSES: (1) How are women orthopaedic surgeons and residents represented in orthopaedic journals compared with men? (2) Have these proportions changed in the past two decades in light of relatively new efforts to recruit women to the field of orthopaedic surgery? METHODS: The gender composition of editorial boards and first and last authors were obtained from the 1997, 2007, and 2017 volumes of the following journals: The Journal of Bone & Joint Surgery (JBJS), the Journal of the American Academy of Orthopaedic Surgeons (JAAOS), and Clinical Orthopaedics and Related Research® (CORR®). Gender neutral names were searched to obtain a picture to ensure proper tallies. RESULTS: The total combined amount of women first and last authors increased from 88 of 1450 (6%) in 1997 to 152 of 1912 (8%) in 2007 to 723 of 5391 (13%) in 2017. Similarly, three of 113 (3%) editorial board members were women in 1997, three of 105 (3%) were women in 2007 and 10 of 107 (9%) editors were women in 2017. Of note, 0 out of 9 editors-in-chief were women. CONCLUSIONS: Based on the current percentage of women orthopaedic surgeons and residents, women are represented equally or in greater numbers as editors and authors in JAAOS, JBJS, and CORR. This may be in part due to women orthopaedic surgeons entering academic medicine at a greater rate than males. CLINICAL RELEVANCE: Orthopaedic surgeons serving as mentors to prospective female applicants can cite female representation on editorial boards and as authors as an example of gender parity in the field. Additionally, active orthopaedic surgeons who are women interested in these leadership positions should be encouraged that these opportunities exist, regardless of gender.
The role of gender-specific factors in the choice of specialty training in obstetrics and gynecology: results from a survey among medical students in Germany Open PDF
(2022)
Riedel, Maximilian
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Hennigs, André
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Dobberkau, Anna Maria
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Riedel, Caroline
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Bugaj, Till Johannes
PURPOSE: The field of obstetrics and gynecology (OB/GYN) is facing growing competition for young professionals in Germany, with high interest rates among female graduates and a declining proportion of male students who choose residency training in the field. The aim of this study is to analyze general and gender-dependent factors that influence the decision for or against specialty training in OB/GYN among medical students in Germany. METHODS: Between February and November 2019, n = 346 medical students in their 5th and 6th year of undergraduate training at Heidelberg University received a questionnaire with 44 items. RESULTS: n = 286 students (61.3 female; 38.7% male) participated in the study. 28% of the female students and 9% of the male students had considered OB/GYN for their specialty training. The students reported different general and gender-specific influencing factors in their choice of a specialty. Both genders desired a good work-life-balance, however, in comparison with their female colleagues, male students had heavily weighted factors related to their later careers and professional success, including competition among colleagues. Male students had gained little practical experience during compulsory internships (26.9% for females vs. 8.8% for males) or had chosen their final-year elective in OB/GYN (15.9% for females vs. 5.5% for males). Female students had worried about the negative effects of their sex on their career (35.4% for females vs. 5.9% for males). CONCLUSION: OB/GYN must become more appealing and attractive to young female and male professionals alike. A better compatibility of career and family should go hand in hand with the implementation of differentiated, (extra) curricular teaching approaches that take the different preferences of female and male students into account.
Gender Gap in academic medicine: a narrative review and the Italian forensic context
(2024)
De Paola, L.
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Spadazzi, F.
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Ottaviani, M.
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Pellegrini, L.
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Imbriani, M.
BACKGROUND: Gender gap is a neologism that identifies the disparity between social and professional conditions experienced by females compared to males. The disparity increases as one ascends the academic hierarchy. In recent years, the debate has expanded, and more options have been planned for the elimination of the current gender gap. METHODS: This research was conducted by examining the landscape of the gender gap, particularly in the academic forensic medicine field. Our analysis involved reviewing papers published between 2006 and 2024, identified through electronic database searches (PubMed). The search terms used were: "gender gap" AND "academic" AND "medicine" AND "leadership." In total, we analyzed 85 papers. Additionally, we examined data from forensic medicine residency programs. CONCLUSIONS: The representation of women in medicine is well-known. Despite the increasing number of women in leadership positions in medicine, they still lag significantly behind men. These data highlight a situation that could be seen as grounds for an accusation of "academic abuse". In the Italian forensic residency programs, less than 20% are led by women, and among these, not all hold the rank of full professor. Although a certain rebalancing is already underway, the gap is still significant. There are already regulations obliging local authorities to promote gender equality in councils, companies, and institutions under their jurisdiction. It would be desirable to consider minimum quotas for female participation in university competitions. This would be a first step toward eliminating the gender gap in academic and forensic medical fields.
Scholarly Productivity Among Academic Foot and Ankle Surgeons Affiliated With US Podiatric Medicine and Surgery Residency and Fellowship Training Programs Open PDF
(2021)
Casciato, Dominick J.
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Cravey, Kimberly S.
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Barron, Ian M.
Foot and ankle surgeons practicing within academic medicine balance clinical or surgical training, course instruction, administrative duties, and research. Along with clinical skills and patient volume, promotion within academia often relies on scholarly productivity. Previous research across specialties described this productivity using variables including publications, citations, and the h-index, a scale that quantifies the productivity and citation impact of published works, among academic ranks. As no studies examine the scholarly impact of foot and ankle surgeons with academic appointments, this study aimed to analyze the productivity and gender differences present in this specialty. A systematic review of academic-affiliated foot and ankle surgery residencies and fellowships was performed; and faculty members were screened for sex, academic rank, publication history, citations, h-index, and years in practice. Among 234 programs reviewed, 44 programs allowed for the analysis of 106 practitioners with an academic rank eligible for analysis. Overall, 78.3% of practitioners were male with the most common rank being assistant professor. Men published more documents and maintained higher citations as well as longer years in practice, and this was significant (p < .05). A significant difference was exhibited among all academic ranks (p ≤ .001). Multivariate regression revealed the publication history and years in practice are strongly correlated with the h-index of providers (p ≤ .001). Foot and ankle surgeons practicing in an academic setting may use the results of this study to gauge their productivity and identify benchmarks that similar providers have met at varying academic ranks.

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