A new study led by University of Arizona researchers found a significant disagreement in the objective versus subjective scoring assessments of female surgical trainees compared to those of their male counterparts.
The findings indicate that gender may play an unfair role in attending surgeons’ technical evaluations of surgical residents, according to the study published in the Journal of Surgical Education.
The paper examined the subjective technical skills scores given to general surgical chief residents by attending surgeons and the blinded Fundamentals of Laparoscopic Surgery scores of the same group at the University of Arizona.
It is the first study to explore discrepancies in trainee technical evaluations, contributing another valuable quantifiable measurement of bias to a growing body of work exploring how implicit bias in surgery influences decreasing representation of minorities throughout academic and professional hierarchies.
Alexandra Turner, MD, Assistant Professor of Surgery at the University of Arizona and senior author of the paper, said ensuring technical evaluations are accurate is important because that feedback – especially when it underestimates the actual skill level – can undermine a trainee’s confidence, understanding of their capabilities and vision for their future.
“Implicit bias can have a long standing impact on trainees, negatively impacting their confidence and learning environment,” Dr. Turner said.
Identifying implicit bias and its influence will hopefully help further more equitable professional advancement among current surgeons, but the downstream effects could also be significant. Increasing diverse representation across all levels improves patient care, and it helps aspiring physicians like Arabella Dill-Macky, former research intern in the Department of Surgery and first author on the paper, see a space for themselves in the field.
“Normalizing marginalized identities in positions of power and authority is so important,” Dill-Macky said. “It creates the world that I would want to live in. I don't think that world exists right now, but I believe that the best thing I can do is to become a leader in my field to help make someone else in a marginalized position feel more comfortable, safe and seen.”
Scores from 29 chief residents from 2015 to 2019 were included in the analysis, with women accounting for 22% and underrepresented minorities for 27%. The results revealed a statistically significant difference in agreement between subjective and objective technical scores for individual female trainees, and a trend toward agreement of these two scores for male trainees. The researchers also looked for inconsistencies in the evaluation of URM residents but found none that were statistically significant.
Drawing strong statistical conclusions from the study is difficult because of the small number of residents included in the initial analysis, “but that's how these things start,” Dr. Turner said.
“Implicit bias is something that is by definition hard to quantify, and there has been a lot of recent creative research that has quantified this as it relates to surgery and surgery education,” she said. “I wanted to start with a pilot project and use the data to impact future behavior by creating awareness of attending scoring practices. The point is to take our temperature and see where we can get better and change.”
Dill-Macky, a Tucson native and now a pre-med junior at Princeton University, originally reached out to Dr. Turner through Princeton’s alumni network. Looking for work like many students who had their summer plans thwarted by COVID-19 in 2020, Dill-Macky and Dr. Turner agreed to work together on the project that they both hope will lead to deeper insights and further research into implicit bias.
For Dr. Turner, that means broadening the project by including other institutions, and for Dill-Macky, it’s expanding the scope to include all gender identities.
“Gender discrimination is very real, and it doesn't apply to just female-identifying people, although our study was focused on the difference between men and women,” Dill-Macky said. “There is an entire spectrum of other gender identities that exist that are simply invisible to medical research. I'm so happy to have been a part of this study starting to highlight some of the implicit bias that still exists within medicine that many people just aren't aware of.”