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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 Trends in Academic Radiology Publication in the United States Revisited Open PDF
(2018)
O'Connor, Erin E.
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Chen, Pauline
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Weston, Brian
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Anderson, Redmond
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Zeffiro, Timothy
RATIONALE AND OBJECTIVES: Although substantial increases in publications by female academic radiologists have appeared over the last several decades, it is possible that the rate of increase is decreasing. We examined temporal trends in gender composition for full-time radiology faculty, radiology residents, and medical students over a 46-year period. METHODS: We examined authorship gender trends to determine if the increases in female authorship seen since 1970 have been sustained in recent years and whether female radiologists continue to publish in proportion to their numbers in academic departments. Original articles for selected years in Radiology and in the American Journal of Roentgenology between 1970 and 2016 were examined to determine the gender of first, corresponding, and last authors. Generalized linear models evaluated (1) changes in proportions of female authorship over time and (2) associations between proportions of female authorship and female radiology faculty representation. RESULTS: While linear increases in first, corresponding, and senior authorships were observed for female radiologists from 1970 to 2000, the rate of increase in female first and corresponding authorships then changed, with the slope of the first author relationship decreasing from 0.81 to 0.34, corresponding to 47% fewer female first authors added per year. In contrast, the proportion of female last authorship continued to increase at the same rate. The proportion of female first authorship was linearly related to the proportion of female radiology faculty from 1970 to 2016. CONCLUSIONS: Annual increases in first author academic productivity of female radiologists have lessened in the past 16 years, possibly related to reductions in the growth of female radiology faculty and trainees. As mixed, compared to homogeneous gender, authorship teams are associated with more citations, efforts to encourage more women to pursue careers in academic radiology could benefit the radiology research community.
Revisiting the Gender Gap in Orthopaedic Surgery: Investigating the Relationship Between Orthopaedic Surgery Female Faculty and Female Residency Applicants. Open PDF
(2019)
Munger, Alana M.
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Heckmann, Nathanael
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McKnight, Braden
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Dusch, Marie N.
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Hatch, George F. 3rd
INTRODUCTION: Although women now constitute approximately half of all graduating medical students, orthopaedic surgery continues to lag behind in its ability to recruit female applicants. One hypothesis for this discrepancy is the lack of female faculty mentors at academic institutions. The three objectives of this study were the following: (1) to quantify the proportion of female orthopaedic surgery residency applicants, (2) to quantify the proportion of female orthopaedic surgery faculty, and (3) to investigate the relationship between female orthopaedic surgery faculty at an academic institution and the corresponding number of female orthopaedic surgery residency applicants. METHODS: Data from the Association of American Medical Colleges from 2005 to 2014 were used to calculate the number of medical school graduates, the number of orthopaedic surgery residency applicants, and the number of orthopaedic full-time faculty in the United States. Institutions were excluded if they had incomplete data. A Spearman rank correlation was used to assess for a correlation between the 9-year total number of female orthopaedic surgery applicants and the average number of female orthopaedic surgery faculty members. RESULTS: A total of 101 U.S. medical schools were included in the final analysis. During the period examined, women accounted for 48.7% of medical school graduates, 14.9% of orthopaedic surgery applicants, and 13.2% of full-time orthopaedic surgery faculty. The percentage of female residency applicants increased from 13.91% in 2005 to 2006 to 16.02% in 2013 to 2014 while the percentage of female faculty increased from 12.26% in 2005 to 2006 to 15.79% in 2013 to 2014. No correlation was found between the average number of female orthopaedic surgery faculty at an institution and the total number of female orthopaedic surgery applicants from that institution during the study period examined (Rho, 0.0176; P = 0.5957). CONCLUSIONS: The data presented in this study failed to demonstrate a relationship between the number of female faculty and the number of women who apply into orthopaedic surgery, which highlights the complex nature of this issue. More research is needed to examine factors influencing the recruitment of female medical students.
When perception is reality: Resident perception of faculty gender parity in a university-based internal medicine residency program. Open PDF
(2019)
Lukela, Jennifer Reilly
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Ramakrishnan, Aditi
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Hadeed, Nicole
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Del Valle, John
INTRODUCTION: Although women have entered medical school and internal medicine residency programs in significant numbers for decades, women faculty remain underrepresented in senior and departmental leadership roles. How residents perceive this gender disparity is unknown. We sought to assess resident perception of gender parity among departmental leadership and teaching faculty in our internal medicine department, and to determine the actual gender distribution of those faculty roles. METHODS: An anonymous cross-sectional survey was distributed to evaluate resident perception of gender representation of various faculty roles. Using conference schedules, resident evaluations, and our department website, we determined the actual representation of women faculty in department leadership roles, and in clinical and educational activities. RESULTS: 88 of 164 residents (54%) responded. Women residents were less likely than men to perceive that women faculty were equally represented in department leadership (45% men agreed vs. 13% women, p < 0.05), clinical teaching roles (55% men agreed vs. 28% women, p < 0.05), or facilitating educational conferences (45% men agreed vs. 28% women, p = 0.074). In 2017, the internal medicine department at our institution comprised 815 faculty members, 473 men (58%) and 342 women (42%). At that time, women faculty held 5% of senior departmental leadership positions and 21% of educational leadership positions. During the year preceding survey distribution, women faculty attended on internal medicine inpatient wards for 33% of the total number of weeks, staffed 20% of morning reports, and facilitated 28% of noon conferences. DISCUSSION: Women residents in our internal medicine training program perceived a gender disparity among faculty in leadership and educational positions to a greater extent than male residents. The perception of women trainees was accurate. In addition to disproportionate underrepresentation in leadership positions, women faculty were underrepresented in prominent educational positions, including attending on inpatient services and serving as discussants at educational conferences.
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.

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