151 - Impact Of Gender On Competency Milestones And Entrustment Scores In An Established Pediatric Resident Assessment Program

Poster Number: 151
Publication Number: 151.218

Jana Jaffe, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States; Mark D. Adler, Northwestern University The Feinberg School of Medicine, Chicago, IL, United States; Karen Mangold, Ann & Robert H. Lurie Children's Hospital/Feinberg School of Medicine/Northwestern, Chicago, IL, United States; Anisha Kshetrapal, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States

Background: As graduate medical education shifts toward a competency-based model, assessment of competency and entrustment is critically important. Implicit gender bias leads to differences in assessment. Studies examining gender differences in resident milestone assessment data demonstrate variable results. It is necessary to understand possible threats to the integrity of trainee assessment, including implicit gender bias.

Objective: To determine if observational competence and entrustment scores differ by resident and assessor gender in a program of assessment.

Design/Methods: A formative assessment program was developed for 2nd year pediatric residents to assess clinical and interprofessional skills. Trained raters (faculty and advanced trainees) assessed performance of simulated cases using anchored global rating scales of competency based on the Accreditation Council for Graduate Medical Education (ACGME) pediatric milestones and entrustment using an entrustable professional activity (EPA) scale (as described by ten Cate). We evaluated two competency measures: (1) the ability to provide seamless transfer of care (PC3) and (2) the ability to make informed decisions (PC4). We conducted retrospective analysis using competency (PC3, PC4) and entrustment scores using de-identified data from five cases from 2016 to 2021. ANOVA and Spearman correlation tests were used.

Results: Data from 148 residents and 29 raters was available. 79% of residents were female, 21% were male. Of raters, 75% were female and 25% were male. Both competency scores were found to be independently correlated with entrustment score (r=0.48, r=0.58). There was no impact of rater nor resident gender on PC4 scores. However, male raters scored 0.5 points lower than female raters on PC3 regardless of resident gender (p < 0.05). In the ANOVA model, neither rater nor resident gender affected entrustment scores.Conclusion(s): We did not identify a significant difference in competence or entrustment scores of trainees based on resident or rater gender. While several factors may explain this including researcher-assigned gender, predominance of women in pediatrics, limitations regarding the non-parallel use of the competence and entrustment scales, use of milestone ratings in one setting rather than longitudinally, and nesting of raters within cases, it is reasonable to postulate that use of rater training and anchored scales contribute to lack of impact from gender bias. Future work should investigate gender bias using methods to address the limitations of this retrospective work.