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Tuesday, March 16, 2000

No institutional bias in residency selection

A study to determine whether female candidates for orthopaedic residency programs are ranked equally to male candidates who have similar qualifications found there is no institutional bias against women in the initial stage of the application process.

The results, presented Wednesday in scientific paper 164, ran counter to the researchers' null hypothesis that women candidates would be ranked lower than their male counterparts, reflecting subtle or perhaps unconscious doubts about their suitability for the field, and the reviewers' desires to maintain the status quo.

That might have been one reason for the fact that in 1998, women accounted for 42 percent of medical school graduates, but only 6.9 percent of orthopaedic residents. Other theories for the disparity are that women do not develop an interest in the field prior to or during medical school, have a misunderstanding about the specialty, or that women interested in orthopaedics perceive a lack of mentors and peers in the field.

The Electronic Residency Application System (ERAS) charts of 90 male and 10 female applicants to the University of Chicago residency program in the 1998 Match were divided into 10 groups, each of nine male charts and one female chart. The charts included the ERAS cover sheet, a personal statement, the USMLE Step I score, and two letters of recommendations, with the signatures of the authors removed.

Each female chart was digitized and computer-manipulated into a "male" version, in which all names and personal pronouns were switched, but which otherwise was identical to the original female version. Each group of 10 charts existed as a paired set: one containing the true female chart and one containing the altered "male" chart.

Faculties of 14 large, university-based orthopaedic residencies around the country served as chart reviewers. Reviewers were not told the true purpose of the study. They were asked to rank the candidates from 1 to 10, with 1 being the best, in the order in which they would like to have the candidates as residents in their own programs. Each institution was randomized to receive either the "male" or female version of each set of 10 charts. The review of the charts was completed by 121 of 140 reviewers. Each chart was reviewed by five to seven separate reviewers.

The mean ranking for the 10 female charts as a group was 5.10 (standard deviation 2.01) and that for the 10 "male" charts was 5.43 (standard deviation 2.39). The mean difference (female-male) was -0.34 (standard deviation 1.51). The p-value for the difference in female-"male" rankings was 0.5, which was not statistically significant.

An analysis of the findings showed that females were more likely to be ranked better by reviewers in the 40 to 50 year age group than in other age categories. The researchers found this "surprising." One explanation is that the reviewers in this age group are likely to have daughters of an age who are participating in higher education and job competition and therefor the reviewers have had their consciousness raised about the gender issue.

Co-authors of the study, all of the University of Chicago, department of surgery, section of orthopaedic surgery, are Susan A. Scherl, MD, assistant professor of clinical surgery; Nicole Lively, BS, research assistant; and Michael A. Simon, MD, professor of surgery, department of surgery, chief, section of orthopaedic surgery.

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2000 Academy News March 16 Index C

Last modified 23/February/2000 by IS