Quantifying the effect of perceived gender identity on competency-based performance evaluations of surgical media

Abstract

Evaluations of medical professionals are crucial for ensuring patient safety. Medical errorsare among the leading causes of death in the United States [1] with the operating room being the most commonplace for errors to occur [2]. The Accreditation Council for Grad- uate Medical Education (ACGME) has developed a competency-based medical education (CBME) program since 1999[3]. CBME is defined as ”an outcomes-based approach to the design, implementation, assessment, and evaluation of medical education programs, using an organizing framework of competencies” [4] and competency ”describes a key set of abil- ities required for someone to do their job” [5]. CBME focuses education on the individual learner instead of time-based progression [5]. For CBME to be effective, the role of bias in the evaluation process must be eliminated. A possible source of bias is the evaluatee’s gender. Studies have shown that gender bias exists in non-medical fields, impacting the perceived competency of an individual[6]–[9]. In medical education, gender bias research focuses on non-surgical evaluations using broad metrics [10]–[14]. Studies that did not find bias stated the need for further research due to being in simulated environments [11], underpowered statistical analysis, and the need for more sophisticated methodology [10]. In surgical education, the focus of gender bias research has been on the experience of female residents [15]–[17]. Gender bias in surgical competency-based performance has not been addressed. The objective of this research is to quantify the effect of perceived gender identity on competency-based performance evaluations of surgical media when evaluated by an expert and non-expert raters. The surgical media will consist of two surgical images (surgical scars, pedicle screw placement) and one type of surgical video (laparoscopic suturing). Each media piece is correlated with patient outcomes and will be evaluated using validated scales specific to each task. The surgical images chosen represent scenes that an evalu- ator would see in person (scars on a patient, pedicle screw on fluoroscopy). Videos of laparoscopic surgery tasks are commonly evaluated. If gender bias is found, the metrics for evaluating competency can be reevaluated. This study focuses on gender bias in surgi- cal media but, once proven, the methods could test for other types of bias in CBME.