Thursday, December 29, 2022

Performance Assessments in Graduate Medical Education May Be Biased Toward White Residents

Internal medicine residents who are Asian or belong to racial groups that are underrepresented in medicine often receive lower ratings on performance assessments than their White peers in the first and second years of postgraduate training, a study in JAMA Network Open has found. The findings suggest a racial and ethnic bias in trainee assessment that may have a far-reaching impact.

“This disparity in assessment may limit opportunities for physicians from minoritized racial and ethnic groups and hinder workforce diversity,” wrote Dowin Boatright, M.D., M.B.A., M.H.S., of the New York University Grossman School of Medicine and colleagues. For example, trainee assessments are often considered in decisions regarding promotion, chief resident selection, readiness for unsupervised practice, and entry into competitive subspecialty graduate medical education programs.

The researchers examined data from the performance assessments of 9,026 internal medicine residents from the graduating classes of 2016 and 2017 who were in internal medicine residency programs accredited by the Accreditation Council of Graduate Medical Education (ACGME). Among the residents, 50.4% were White, 36.1% were Asian, and 13.5% belonged to groups that are underrepresented in medicine, defined as Latinx only; non-Latinx Native American, Alaska Native, or Native Hawaiian/Pacific Islander only; or non-Latinx Black. The researchers focused on scoring for the midyear and year-end ACGME Milestones. These Milestones are used by residency programs’ Clinical Competency Committees to assess residents’ knowledge, skills, attitudes, and other attributes in clinical competency domains such as medical knowledge, patient care, professionalism, and others.

The researchers found no significant difference in the first postgraduate year (PGY) midyear total Milestone scores between White residents and residents from groups underrepresented in medicine. However, total Milestone scores were a median of 1.27 points higher for White residents compared with Asian residents.

From the midyear PGY1 assessment onward, White residents began to receive increasingly higher scores compared with Asian residents and residents from groups underrepresented in medicine. These disparities peaked in PGY2, when White residents’ total scores were a mean of 2.54 points higher than those of residents from groups underrepresented in medicine and 1.9 points higher than Asian residents. However, the gap in scores narrowed by the PGY3 year-end assessment, when the researchers found no racial and ethnic differences in the total Milestone scores.

The researchers also found differences in the ratings for individual clinical competency domains between White residents and Asian residents and residents from groups that are underrepresented in medicine, with White residents scoring higher than the other groups.

“Although differences in ratings … in competency domains were small, these inequalities could reflect substantive differences in how residents from minoritized racial and ethnic groups are perceived in summative assessments,” Boatright and colleagues wrote.

For related information, see the Psychiatric News article “Leadership, Centering Equity Vital to Future of Medical Education.”

(Image: iStock/Cecilie_Arcurs)

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