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In one institution's surgery department, senior male residents received better evaluations than their female counterparts, further evidence of gender bias in the specialty, researchers found.

Among residents in their graduating year (PGY-5), men had higher median scores than women on knowledge of surgical diseases (3.80 vs 3.58, P=0.01) and operative knowledge (3.67 vs 3.50, P=0.01), Caitlin Smith, MD, of the University of Washington in Seattle, and colleagues reported in a research letter in .

"Myriad opportunities have been proposed to decrease gender bias in surgery, but they require recognition of the problem and commitment to implementing change," Smith and colleagues wrote.

For their study, they reviewed all ACGME Milestone evaluations for surgical residents at the University of Washington from 2013 to 2019, totaling 1,249 evaluations of 196 general surgical residents, 76 of whom were women (38.8%).

The team calculated a mean score for each resident per each academic year across seven categories that was based on four to 10 faculty evaluations. The investigators also looked at the percentages of men and women in their fifth year who achieved mean scores of 3.7 and higher or 4 (which is considered the standard for competency) in those categories.

In addition to the senior resident findings, women tended to score lower than men on operating knowledge and teaching across all 4 years, though these findings weren't significant.

Only one fifth-year female resident (6.7%) achieved a mean score of 4 in any category -- and that was in patient and family-centered communication, Smith and colleagues reported.

By comparison, 4.8% to 28.6% of men got a mean score of 4 across the categories with the exception of teaching: one in knowledge of disease, two in operating knowledge, four in professionalism, six in health and well being, three in administrative tasks, and two in patient and family-centered communications.

Only 20% to 53.5% of women achieved a mean score of 3.7 or higher across those seven categories, compared with 42.9% to 66.7% of men, Smith and colleagues also found.

The study was limited because it couldn't investigate the impact of gender concordance between residents and evaluators; nor could it assess for race, ethnicity, or sexual orientation. Nonetheless, the authors wrote that the findings require further investigation.

"Despite limitations, the pattern of men receiving higher scores on evaluations than women is notable especially when evaluations at the end of training show disparity," the researchers wrote. "Trainees may experience differential assessment in surgical knowledge and operative skills based on gender."

Another explanation, Smith and co-authors noted, "could be that gender bias throughout training may result in a wider knowledge and skills gap that is accentuated as accumulated experience becomes differential further in training."

The team said that while the reasons for the differences are "likely multifactorial, the findings will be used to inform internal queries and improvement at our institution."

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