CLERKSHIP DIRECTORS IN EM
Mitigating Bias in Evaluations in Medical Education
SAEM PULSE | JANUARY-FEBRUARY 2021
By Emily Earl-Royal, MD, MPH; Al’ai Alvarez, MD; and Danielle Miller, MD, MEd(c) on behalf of the SAEM Clerkship Directors in Emergency Medicine academy.
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The impact of the COVID-19 pandemic on the availability of away rotations forced an overhaul on recruiting and selecting learners in medical education. However, structural biases in evaluations undermine our efforts to advance diversity, equity, and inclusion. Pipeline efforts toward equity and representation continue to be leaky due to the biased ways we assess and present learners. Studies have shown that early in the medical education and recruitment process, medical schools produce biased letters of evaluations, including gender and racial disparities in medical student performance evaluations (Eval. Health Prof, PLoS). Another study indicated that disparities also exist in membership at the Alpha Omega Alpha (AOA) National Medical Honorary Society. In emergency medicine residency, there is evidence for gender
“Pipeline efforts toward equity and representation continue to be leaky due to the biased ways we assess and present learners.” bias in milestones in clinical competency (J Grad Med Educ, JAMA Intern Med). Furthermore, according to one study, stereotypical male personality traits reflect an “ideal” resident in emergency medicine. These male-based characteristics include descriptors such as “takes charge,” “leadership in teams,” “autonomous,” “decisive,” “motivated,” “confident,” “doesn’t complain,” and “doesn’t get frustrated.” When evaluated in this category, women
residents have a more challenging time establishing their competence on traits that are traditionally considered masculine. These biased evaluations compound over time to limit access to acquiring highly-sought career opportunities such as becoming chief resident, acquiring prestigious residency and fellowship positions, receiving national awards, and obtaining senior leadership. Understanding the challenges and barriers to overcoming