Objectives: Prior research has demonstrated that men and women emergency medicine (EM) residents receive similar numerical evaluations at the beginning of residency, but that women receive significantly lower scores than men in their final year. To better understand the emergence of this gender gap in evaluations we examined discrepancies between numerical scores and the sentiment of attached textual comments. Methods: This multicenter, longitudinal, retrospective cohort study took place at four geographically diverse academic EM training programs across the United States from July 1, 2013-July 1, 2015 using a real-time, mobile-based, direct-observation evaluation tool. We used complementary quantitative and qualitative methods to analyze 11,845 combined numerical and textual evaluations made by 151 attending physicians (94 men and 57 women) during real-time, direct observations of 202 residents (135 men and 67 women). Results: Numerical scores were more strongly positively correlated with positive sentiment of the textual comment for men (r = 0.38, P < 0.001) compared to women (r = -0.26, P < 0.04); more strongly negatively correlated with mixed (r = -0.39, P < 0.001) and negative (r = -0.46, P < 0.001) sentiment for men compared to women (r = -0.13, P < 0.28) for mixed sentiment (r = -0.22, P < 0.08) for negative; and women were around 11% more likely to receive positive comments alongside lower scores, and negative or mixed comments alongside higher scores. Additionally, on average, men received slightly more positive comments in postgraduate year (PGY)-3 than in PGY-1 and fewer mixed and negative comments, while women received fewer positive and negative comments in PGY-3 than PGY-1 and almost the same number of mixed comments. Conclusion: Women EM residents received more inconsistent evaluations than men EM residents at two levels: 1) inconsistency between numerical scores and sentiment of textual comments; and 2) inconsistency in the expected career trajectory of improvement over time. These findings reveal gender inequality in how attendings evaluate residents and suggest that attendings should be trained to provide all residents with feedback that is clear, consistent, and helpful, regardless of resident gender.
Journal Article Review of "Spaces on the Spectrum: How Autism Movements Resist Experts and Create Knowledge" Get access Review of "Spaces on the Spectrum: How Autism Movements Resist Experts and Create Knowledge" By Catherine Tan Columbia University Press, 2024, 289 pages, price: $130.00 (cloth) / $32.00 (paper) / $31.99 (e-book). https://cup.columbia.edu/book/spaces-on-the-spectrum/9780231556330 Alexandra Brewer Alexandra Brewer University of Southern California Search for other works by this author on: Oxford Academic Google Scholar Social Forces, soae109, https://doi.org/10.1093/sf/soae109 Published: 30 August 2024 Article history Received: 13 June 2024 Accepted: 24 June 2024 Published: 30 August 2024
Why do women continue to face barriers to success in professions, especially male-dominated ones, despite often outperforming men in similar subjects during schooling? With this study, we draw on role expectations theory to understand how inequality in assessment emerges as individuals transition from student to professional roles. To do this, we leverage the case of medical residency so that we can examine how changes in role expectations shape assessment while holding occupation and organization constant. By analyzing a dataset of 2,765 performance evaluations from a three-year emergency medicine training program, we empirically demonstrate that women and men are reviewed as equally capable at the beginning of residency, when the student role dominates; however, in year three, when the colleague role dominates, men are perceived as outperforming women. Furthermore, when we hold resident performance somewhat constant by comparing feedback to medical errors of similar severity, we find that in the third year of residency, but not the first, women receive more harsh criticism and less supportive feedback than men. Ultimately, this study suggests that role expectations, and the implicit biases they can trigger, matter significantly to the production of gender inequality, even when holding organization, occupation, and resident performance constant.
Gendered differences in workload distribution, in particular who spends time on low-promotability workplace tasks—tasks that are essential for organizations yet do not typically lead to promotions—contribute to persistent gender inequalities in workplaces. We examined how gender is implicated in the content, quality, and consequences of one low-promotability workplace task: assessment. By analyzing real-world behavioral data that include 33,456 in-the-moment numerical and textual evaluations of 359 resident physicians (subordinates) by 285 attending physicians (superordinates) in eight U.S. hospitals, and by combining qualitative methods and machine learning, we found that, compared to men, women attendings wrote more words in their comments to residents, used more job-related terms, and were more likely to provide helpful feedback, particularly when residents were struggling. Additionally, we found women residents were less likely to receive substantive evaluations, regardless of attending gender. Our findings suggest that workplace assessment is gendered in three ways: women (superordinates) spend more time on this low-promotability task, they are more cognitively engaged with assessment, and women (subordinates) are less likely to fully benefit from quality assessment. We conclude that workplaces would benefit from addressing pervasive inequalities hidden within workplace assessment, equalizing not only who provides this assessment work, but who does it well and equitably.
How do clinicians manage the negative emotions that emerge when hospital patients are dissatisfied with their pain treatment? Drawing on a 21-month hospital ethnography, I show that clinicians view opioids as tools that can allow them to avoid engaging in emotional labor with dissatisfied pain patients. I detail two different strategies that clinicians pursued. Through permissive prescription, clinicians used intravenous (IV) opioids liberally to placate unhappy pain patients, temporarily minimizing patients' emotional needs. Through restrictive prescription, clinicians advocated for the more conservative use of IV opioids in the hopes that dissatisfied patients would leave the hospital, reducing their overall emotional workload. Divergent strategies for using opioids to avoid emotional labor led to hierarchical interprofessional conflict, which was itself a source of negative emotions that needed to be managed. Based on these findings, I argue that the desire to avoid emotional labor can shape patient care and workplace relationships.
Resource shortages unfold unequally, often affecting the most socially disadvantaged people and exacerbating preexisting inequalities. Given that most resources are obtained through organizations, what role do organizational processes play in amplifying inequalities during shortages? I argue that workers engage in a practice I term flexible austerity. Flexible austerity describes how resource shortages become opportunities for decision-makers to more readily rationalize unequal resource allocation. I develop this concept by drawing on an ethnography of an urban academic hospital and leveraging data from before and during a nationwide shortage of medical intravenous (IV) opioids. I show that prior to this shortage, clinicians disproportionately assessed Black patients’ pain as “undeserving” of IV opioids, but they allocated these resources liberally because they felt constrained by evidence-based clinical best practices guidelines. During the shortage, clinicians constructed resource scarcity as necessitating austerity practices when treating Black patients, yet they exercised flexibility with White patients. This widened care disparities in ways that may have been detrimental to Black patients’ health. Based on these findings, I argue that resource shortages amplify inequalities in organizations because they provide new “colorblind” justifications for withholding resources that allow workers to link ideas of deservingness to allocation decisions.
