Exploring Gender Bias in Nursing Evaluations of Emergency Medicine Residents

Abstract

Objectives: Nursing evaluations are an important component of residents' professional development as nurses are present for interactions with patients and nonphysician providers. Despite this, there has been few prior studies on the benefits, harms, or effectiveness of using nursing evaluations to help guide emergency medicine residents' development. We hypothesized that gender bias exists in nursing evaluations and that female residents, compared to their male counterparts, would receive more negative feedback on the perception of their interpersonal communication skills.Methods: Data were drawn from nursing evaluations of residents between March 2013 and April 2016. All comments were coded if they contained words falling into four main categories: standout, ability, grindstone, and interpersonal. This methodology and the list of words that guided coding were based on the work of prior scholars. Names and gendered pronouns were obscured and each comment was manually reviewed and coded for valence (positive, neutral, negative) and strength (certain or tentative) by at least two members of the research team. Following the qualitative coding, quantitative analysis was performed to test for differences. To evaluate whether any measurable differences in ability between male and female residents existed, we compiled and compared American Board of Emergency Medicine in-training examination scores and relevant milestone evaluations between female and male residents from the same period in which the residents were evaluated by nursing staff.Results: Of 1,112 nursing evaluations, 30% contained comments. Chi-square tests on the distribution of valence (positive, neutral, or negative) indicated statistically significant differences in ability and grindstone categories based on the gender of the resident. A total of 51% of ability comments about female residents were negative compared to 20% of those about male residents (v 2 = 11.83, p < 0.01). A total of 57% of grindstone comments about female residents were negative as opposed 24% of those about male residents (v 2 = 6.03, p < 0.01).Conclusions: Our findings demonstrate that, despite the lack of difference in ability or competence as measured by in-service examination scores and milestone evaluations, nurses evaluate female residents lower in their abilities and work ethic compared to male residents.From the

Addressing the Elephant in the Room: Microaggressions in Medicine

“…15 Consistent with these findings, a recent study demonstrated that despite equivalent competence as measured by in-service examination scores and milestone achievement, nurses evaluated female emergency medicine residents as having less ability and a weaker work ethic compared with their male counterparts. 17 A similar sex gap was revealed in a 2017 study examining faculty evaluation of resident milestone attainment. 18 These studies suggest that implicit biases inform both nursing and faculty perceptions of female residents, which may in turn affect how female versus male residents are treated in the workplace.…”

Direct Observation Tools in Emergency Medicine: A Systematic Review of the Literature

“…Sex biases and inequality have been demonstrated in EM among attending physicians, but the data among EM residents are more limited. [67][68][69][70][71] Dayal et al 18 found that female residents had a lower overall rating on end-of-shift evaluations compared with male residents, while Mueller et al 29 found that female residents received less consistent feedback than male residents. Interestingly, Siegelman et al 32 did not find a difference in scoring between male and female residents in their simulation-based OSCE study.…”

Implicit bias in healthcare: clinical practice, research and decision making

“…34 In addition, female residents (registrars) have significantly negative evaluations by nursing staff compared with their male colleagues despite similar objective clinical evaluations between male and female colleagues. 36,37 One alarming disparity that deserves mention is gender-specific differences in myocardial infarction presentation and survival. While members of both genders present with chest pain, women often present with what is known as 'atypical' symptoms such as nausea, vomiting and palpitations.…”