Gender Representation Matters: Intervention to Solicit Medical Resident Input to Enable Equity in Leadership in Graduate Medical Education

Acad Med. 2020 Sep 1. doi: 10.1097/ACM.0000000000003698. Online ahead of print.

Abstract

Problem: Gender equity in leadership across academic medicine remains a concern. The case of chief resident (CR) offers an opportunity to explore leadership emergence in graduate medical education (GME). Means of identifying potential candidates for CR often rely on faculty assessment of resident performance, yet implicit gender bias has the potential to influence this assessment.

Approach: To diversify the metrics used in CR selection, an intervention was implemented to solicit resident input to identify candidates for CR at 2 U.S. internal medicine residency programs in 2018 and 2019. This involved a simple, cross-sectional survey of residents in which they were asked to identify individual residents as good candidates for consideration for CR.

Outcomes: There were 298 of 518 internal medicine resident responses to this intervention across sites and years (mean 58.2% response rate). Nomination patterns of residents and program leaders correlated significantly (correlation coefficient 0.62, P < 0.001). Controlling for site and year, gender was a significant factor associated with who residents nominated for CR (β-coefficient 0.325, P = 0.004) with women residents more likely to identify women for CR (odds ratio 1.38, 95% confidence interval 1.11 to 1.73). Fifty residents nominated themselves for CR, and there was no significant difference by gender (β-coefficient 0.038, P = 0.91).

Next steps: Soliciting resident input to identify candidates for CR may enable gender representation of candidates for this position. Future work is needed to explore factors that influence leadership emergence in GME and interventions to enable equity in the training environment.