The impact of gender on clinical evaluation of critical care medicine trainees
CCCF ePoster library. Spring J. Nov 7, 2018; 234659; 131
Dr. Jenna Spring
Dr. Jenna Spring
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Multiple studies have shown important gender disparities in assessment in medical education.  In high acuity settings such as the Emergency Department, evidence has demonstrated differences in the feedback provided to female and male trainees1. These assessments often emphasize traits usually considered as masculine, such as decisiveness, confidence, independence, or a take charge approach. Similarly, leadership based on stereotypical male characteristics may be perceived by assessors as more effective in the ICU context. In light of these findings, our study aims to examine whether there are gender discrepancies in trainee evaluations for ICU rotations, with a focus on overall evaluations as well as specific sub-domains. 


Our primary objective was to determine whether male and female Critical Care Medicine (CCM) trainees were evaluated differently based on quantitative evaluations during rotations in the ICU. We also examined whether there were differences in these evaluations over time or level of training based on gender.


In this retrospective cohort study, we reviewed the in-training evaluation reports (ITERs) for Canadian Royal College CCM trainees rotating through the five core academic ICUs at the University of Toronto between the 2007-2008 and 2016-2017 academic years. The mean global rating for the rotation was compared between male and female trainees as well as the mean rating for the components of each CanMEDS subdomain, which is the evaluation framework for Canadian trainees. Ratings for procedural skills were also evaluated. All scores were reported on a scale of 1 (fails to meet expectations) to 5 (outstanding). The Wilcoxon rank sum test was used to compare scores between genders while a linear model was used to compare scores over time.


A total of 624 ITERs were included in the study, 438 for males and 186 for females. The majority of ITERs were for trainees in their PGY-4 (n=208) or PGY-5 (n=186) training year. The mean overall score on the ITER was 4.33 (IQR 4.00-5.00) for females and 4.31 (IQR 4.00-5.00) for males (p=0.92).  For females, the average overall score by year was 4.23, 4.41, 4.27, and 4.53 for the PGY-4, PGY-5, PGY-6, and PGY7+ years respectively. This compared to a mean overall score of 4.27, 4.37, 4.21, and 4.45 for male trainees at the same levels. These differences were not statistically significant (table 1). There were also no significant differences in scores between male and female trainees across any of the competency subdomains (table 2) or between the two genders over time (figure 1).


In this retrospective study of CCM trainees at a large Canadian academic centre, there were no differences in evaluations between male and female trainees. This included trends over time, comparisons at each training level, and across competency subdomains.  While this is in contrast to previous literature, the trainees in our study were very senior and had already successfully matched to a CCM training program. This process in and of itself may select for individuals who are more likely to possess certain traits, reducing variability in assessment. Furthermore, our study was limited to quantitative written feedback, and the range in scores was narrow which may impact our ability to capture subtle differences in assessment. Further research is needed to address qualitative feedback in the ICU environment, as well as evaluation of more junior trainees.

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