Study shows female physicians judged more harshly than males during emergency medicine training

Male and female resident physicians were judged as equally capable during their first year of a three-year emergency medicine training program, according to a new study. By year three, however, supervising physicians viewed the women as less capable and gave them harsher criticism than men who made medical errors of similar severity.

“The attending physicians who oversaw the residents viewed both the men’s and women’s performances positively during their first year, when residents are expected to fulfill more of a student role — listening, learning,” said Alexandra Brewer, a doctoral student in sociology at the University of Chicago and first author of the study published in the journal American Sociological Review. “But by year three, when trainees are expected to fill more of a professional role, the reverse happens.”

Vineet Arora, MD, assistant dean for scholarship and discovery for the University of Chicago Pritzker School of Medicine and a national leader in medical education, is one of the co-authors.

“What we found is that the women residents, when they start out, they’re given the benefit of the doubt,” Arora said. “They actually get more positive comments than the men, but as the residency progresses, they get harsher criticism and less supportive feedback than the men. That’s concerning, because your third year of residency is right before you start your professional practice. This could result in women physicians having self-doubt about the care they deliver.”

The researchers based their study on written comments made by supervising physicians in an Accreditation Council for Graduate Medical Education (ACGME)-accredited emergency medicine residency program at an unnamed hospital from 2012-2015.

The supervising physicians used a mobile app called InstantEval V2.0, which allows for real-time evaluation. (The app was developed by two of the other study authors.) InstantEval encourages attending physicians to perform up to three evaluations per shift and to numerically score residents on how well they meet ACGME milestones, along with the option of adding a text comment about the residents’ performances.

The researchers found that during the first year, the attending physicians expect the residents still to act more like students —listening, showing deference to authority and asking questions. Sociological research shows these behaviors are conventionally viewed as feminine.

During the third year, however, supervisors expected the residents to act more like colleagues — a role that can be described as showing confidence and being assertive. These behaviors are conventionally viewed positively in men. Other studies have shown that when women exhibit these traits, they’re often seen as aggressive or overly assertive.

The supervising physicians evaluating third-year residents were more likely to note weaknesses in knowledge, skills or personality among female trainees that they said would prevent them from being competent emergency medical physicians after residency. One female resident, for instance, was criticized for being too meticulous. Male third-year residents were more likely than female residents to be praised for their leadership qualities.

The investigators found female third-year residents were criticized more harshly than male third years for similar medical errors. “She should not be a senior resident,” a supervising physician wrote about a female resident who made a serious error in judgment. For a male resident who made a similarly grave error, a different attending physician, while noting his disappointment, wrote, “I think he has the fundamental knowledge and basic clinical skills.”

“It’s hard to think of any doctor making errors, they hold our lives in their hands,” said co-author Anna Mueller, PhD, a former University of Chicago faculty member and now associate professor of sociology at Indiana University. “But the reality is that making errors is a normal and almost necessary part of residency. If men make errors but the attendings still have faith in their ability to continue their careers, they’ll be okay, but if the same is not true for women…then the women are getting a pretty powerful message that they don’t have what it takes.”

The study, “Who Gets the Benefit of the Doubt? Performance Evaluations, Medical Errors, and the Production of Gender Inequality in Emergency Medical Education,” was published in American Sociological Review. This project was supported by the National Center for Advancing Translational Sciences of the National Institutes of Health through Grant Number ULI TR000430. Additional funding was provided by a University of Chicago Gianinno Faculty Research Award. Additional authors include Melissa Osborne from Western Washington University; Daniel M. O’Connor from Harvard University; and Arjun Dayal from the University of Chicago.