Gender bias in evaluating surgical residency faculty members may be decreasing

CHICAGO: In the male-dominated field of surgery, female faculty of training programs tend to receive lower scores than male faculty on their teaching evaluations, which are important for career advancement, past research has found. Now a new study suggests progress in this apparent gender bias: Among 21 U.S. general surgery residency programs, female faculty scored slightly better overall than male faculty did on teaching evaluations performed by surgeons-in-training, even in programs with the fewest women, the authors report. The study is published as an "article in press" on the Journal of the American College of Surgeons website in advance of print.

These results were unexpected, according to the researchers, because a 2018 study found that female surgical faculty often received lower scores than male faculty did on teaching evaluations,¹ and other study findings also show a negative bias against female faculty in academic medicine.^2,3

"Hopefully, based on our results, we're seeing a shift in attitudes and perceptions of surgical residents about women in surgery and women as educators so that all surgeons are graded on an equal scale," said lead study author Adam Shellito, MD, a fourth-year surgical resident at Harbor-UCLA Medical Center in Torrance, Calif. "This shift will hopefully allow women to reach higher academic positions and leadership positions in surgery."

Nationwide, less than 21 percent of surgeons are women.⁴ Even fewer women hold leadership roles in surgery, with women representing only 18 percent of directors of general surgery residency programs.⁵

For residency program faculty, teaching evaluations are important because the results help determine promotions and tenure, said senior investigator Kristine Calhoun, MD, FACS, associate professor, University of Washington School of Medicine, Seattle.

Multi-institutional study

The study was conducted by members of the Surgery Educators Workgroup, a research collaboration of general surgery residency programs from across the United States. In their data analysis from 21 participating programs, the investigators included only full-time faculty who worked with general surgery residents. They also sent surveys to the program directors to gather information about each program, such as the sex-based composition of both residents and faculty.

Although all the programs require their residents to anonymously complete faculty teaching evaluations online after each surgical rotation, the evaluation tools varied greatly, Dr. Shellito noted. Therefore, the researchers created a composite score for each faculty member. They divided the total number of points a person received by the total possible points for that evaluation tool over the one-year study period from July 2018 to June 2019. For each faculty member and institution, the researchers calculated the percentage score from a maximum 100 percent.

The general surgery programs surveyed varied widely, from 14 to 77 residents and 14 to 155 teaching faculty per program, the researchers reported. Although nearly half (47 percent) of the residents were female, women made up only 28 percent of the faculty.

Evaluations ranged from one to 29 questions, for a total of 291 questions among all programs. In total, there were 20,187 evaluations of 1,177 faculty, according to the article.

Surprising results

Contrary to what the researchers anticipated, female faculty had significantly higher composite evaluation scores on average—90.6 percent versus 89.5 percent for male faculty. Because the difference was small, Dr. Shellito said they would classify the scores as an equalization between sexes.

The researchers also analyzed the results between quartiles of programs with the highest versus the lowest numbers of female faculty, female residents, and both. They found that residents at the programs with fewer women on the faculty and/or residency staff rated female faculty higher overall than male faculty.

This result also surprised the researchers, Dr. Calhoun said. They hypothesized multiple reasons for this finding, she said, including that in programs with few women on the faculty, residents may not have wanted to single them out with poor evaluations, that the female faculty were actually better educators, or that as more women become surgical residents, there is increased awareness of gender bias.

Among North American general surgery residents, 41 percent were women in 2018,⁶ a 5 percent increase from the previous year,⁷ according to the Association of American Medical Colleges.

Regardless of the educator's sex, this study's results showed a high satisfaction rate of surgical residents with their teaching faculty, which Dr. Calhoun called "a powerful finding."

Another finding confirms the importance of their research, Dr. Shellito stated. "More than 75 percent of program directors that we surveyed agree that faculty evaluations are important to the residency program or the institution," he said.

He cautioned, however, that their results suggesting a lack of overt gender bias may not apply to the entire country because more than half of the participating programs were on the west coast. Also, the programs overall had more female residents than the national average⁶ and more female faculty than the average 41 percent among U.S. medical school faculty.⁸

Other institutions that participated in the study are the University of California, San Francisco-Fresno, Calif.; UCLA Health, Los Angeles, Calif.; New York-Presbyterian/Columbia University Medical Center, New York City, N.Y.; Hospital of the University of Pennsylvania, Philadelphia, Pa.; Loma Linda University Health, Loma Linda, Calif.; Cedars-Sinai Medical Center, Los Angeles, Calif.; Brigham and Women's Hospital, Boston, Mass.; Stanford University, Stanford, Calif.; Houston Methodist Hospital, Houston, Texas; University of Nebraska Medical Center, Omaha, Neb.; Baptist Health System, Birmingham, Ala.; Gundersen Health System, LaCrosse, Wis.; University of California, Irvine Medical Center, Orange, Calif.; Santa Barbara Cottage Hospital, Santa Barbara, Calif.; Oregon Health & Science University, Portland, Ore.; University of California, Davis, Davis, Calif.; John A. Burns School of Medicine, Honolulu, Hawaii; University of Hawaii at Manoa, Honolulu, Hawaii (; Southern Illinois University of Medicine, Springfield, Ill.; and WellSpan York Hospital, York, Pa.

"FACS" designates that a surgeon is a Fellow of the American College of Surgeons.

This study was presented Feb. 15, 2020, at the Pacific Coast Surgical Association Annual Meeting in Carlsbad, Calif.

Study authors report no disclosures related to this research.

Citation: Investigating association between gender and faculty teaching evaluations in general surgery residency programs: a multi-institutional study. Journal of the American College of Surgeons. DOI: 10.1016/j.jamcollsurg.2020.05.026.

References

1. Fassiotto M, Li J, Maldonado Y, Kothary N. Female surgeons as counter stereotype: the impact of gender perceptions on trainee evaluations of physician faculty. J Surg Educ. 2018;75(5):1140-1148. DOI:10.1016/j.jsurg.2018.01.011.
2. Morgan HK, Purkiss JA, Porter AC, et al. Student evaluation of faculty physicians: gender differences in teaching evaluations. J Womens Health. 2016;25(5):453-456. DOI:10.1089/jwh.2015.5475.
3. Fassiotto M, Hamel EO, Ku M, et al. Women in academic medicine: measuring stereotype threat among junior faculty. J Womens Health. 2016;25(3):292-298. DOI:10.1089/jwh.2015.5380.
4. Association of American Medical Colleges. Active physicians by sex and specialty. 2017. Accessed June 29, 2020. Available at: https://www.aamc.org/data-reports/workforce/interactive-data/active-physicians-sex-and-specialty-2017.
5. Carpenter AM, Tan SA, Costopoulos K, Cooper LA, Sarosi GA, Shaw CM. Gender diversity in general surgery residency leadership. J Surg Educ. 2018;75(6):e68-e71. DOI:10.1016/j.jsurg.2018.07.021.
6. Association of American Medical Colleges. Percentage of women residents by specialty, 2018. Figure 5 in: The State of Women in Academic Medicine, 2018-2019. 2020. Accessed July 3, 2020. Available at: https://www.aamc.org/sites/default/files/aa-data-reports-state-of-women-residents-specialty-2018_0.jpg.
7. Association of American Medical Colleges. Table B3: Number of active residents, by type of medical school, GME Specialty, and sex: 2017-18 active residents. In: 2019 Report on Residents. 2019. Accessed June 29, 2020. Available at: https://www.aamc.org/data-reports/students-residents/interactive-data/table-b3-number-active-residents-type-medical-school-gme-specialty-and-sex.
8. Association of American Medical Colleges. Percentage of full-time U.S. medical school faculty by gender, 2009-2018. Figure 9 in: The State of Women in Academic Medicine, 2018-2019. 2020. Accessed July 3, 2020. Available at: https://www.aamc.org/sites/default/files/aa-data-reports-state-of-women-full-time-faculty-gender-2009-2018_0.jpg.

About the American College of Surgeons

The American College of Surgeons is a scientific and educational organization of surgeons that was founded in 1913 to raise the standards of surgical practice and improve the quality of care for all surgical patients. The College is dedicated to the ethical and competent practice of surgery. Its achievements have significantly influenced the course of scientific surgery in America and have established it as an important advocate for all surgical patients. The College has approximately 90,000 members and is the largest organization of surgeons in the world. "FACS" designates that a surgeon is a Fellow of the American College of Surgeons.

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