CAEP GeMES | Rate of Milestone Attainment in Male Versus Female Emergency Medicine Residents

In Education & Quality Improvement, Great Evidence in Medical education Summary (GEMeS) by Laura WeingartenLeave a Comment

Crystal is a 3rd year EM resident who is meeting with her program director at her mid-year feedback session to discuss her progress. After she finishes the meeting and is reassured that she is achieving all of her clinical milestones thus far, she grabs dinner with the other 3rd year EM residents in her program. As they all discuss their progress, she realizes that all of the male residents were told in their feedback session that they were achieving their milestones 3 months ahead of schedule. She reflected back on their first year evaluations, where everyone was attaining milestones at the same rate and wonders what could have changed. 

Implicit gender bias may affect the perceived rate of milestone attainment in male versus female residents. This “Great Evidence in Medical education Summary” (GEMeS – pronounced “gems”), titled “Rate of Milestone Attainment in Male Versus Female Emergency Medicine Residents” was originally posted by the CAEP EWG GEMeS Team in August 23, 2017 and answers the question: “Do male versus female emergency medicine (EM) residents had a different rate of milestone attainment during evaluations throughout residency training?” A PDF version of the GEMeS summary is available here.

Article Reference

Dayal A, O’Connor M, Qadri U, Arora VM. Comparison of Male vs Female Resident Milestone Evaluations by Faculty During Emergency Medicine Residency Training. JAMA Intern Med 2017 Mar 6; epub ahead of print. DOI: 10.1001/jamainternmed.2016.9616.

Why is this paper relevant to Emergency Medicine education?

This study suggests that faculty should be aware of possible gender bias in medical education and
residency training. The authors suggest “one way to interpret our findings is that a widening gender gap is attributable to the cumulative effects of repeated disadvantages and biases that become increasingly pronounced at senior levels of training.” In other words, female senior residents who display qualities such as independence or assertiveness may receive lower marks than their male colleagues. Recognizing and further characterizing this possible bias is important as we move towards competency based assessment models in EM and other training programs.

Level of Evidence/Level of Learning

N/A; Postgraduate

Funding Sources

NIH and University of Chicago Diversity Research & Small Grants Program

Study Design and Setting

Multicentre longitudinal cohort study in Eight community and academic EM training programs across the United States


This multicentre study examined over 33 000 milestone evaluations of 359 EM residents (237 men and 122 women) over a two-year period. Milestone evaluations are direct faculty observations of specific skills or subcompetencies.

Female and male residents achieved similar milestone levels during their first year of residency. By the end of a three-year training program, male residents received higher evaluations in all categories – including medical knowledge, airway management, patient safety and team communication.

The rate of milestone attainment was 12.7% higher for men through all levels of residency. In other words, evaluations of male residents placed them over three months ahead of female residents in the same training programs, where residents gain, on average, 0.5 milestone levels per year. There were no statistically significant differences in scores based on gender of the faculty evaluator (194 men and 91 women) or gender pairing between evaluator and resident.

The paper did not identify specific reasons for their observed gender gap in evaluations, but highlighted the need for faculty to be cognizant of possible gender bias and for further research in this area to be performed.


Male and female residents in this cohort received similar evaluations during their first year of a three-year residency program. By graduation, male residents received higher scores than female residents in all 23 categories – which include medical knowledge, airway management, patient safety and team communication. The authors hypothesize this observed evaluation gap may be due to implicit gender bias in residency training.

What can you do to eliminate or reduce implicit gender bias at your institute so that male and female residents are evaluated equally with respect to completion of milestones?


More About the CAEP GEMeS

This post was originally authored for the Canadian Association of Emergency Physicians (CAEP) Great Evidence in Medical Education Summaries (GEMeS)  project sponsored by the CAEP Academic Section’s Education Working Group and edited by Drs. Teresa Chan and Julien Poitras. CAEP members receive GEMeS each month in the CAEP Communiqué. CanadiEM will be reposting some of these summaries, along with a case/contextualizing concept to highlight some recent medical education literature that is relevant to our nation’s teachers.


Laura Weingarten

Dr. Laura Weingarten is a Clinical Assistant Professor at McMaster Children's Hospital with an interest in pediatric disaster medicine and emergency preparedness.

Aaron Leung

Aaron is a fourth year medical student from Western University with an interest in emergency medicine, medical education, and POCUS. Outside of school, he enjoys playing the piano and trying out new restaurants.