Gender Bias in Resident Assessment in Graduate Medical Education: Review of the Literature

  • Robin KleinEmail author
  • Katherine A. Julian
  • Erin D. Snyder
  • Jennifer Koch
  • Nneka N. Ufere
  • Anna Volerman
  • Ann E. Vandenberg
  • Sarah Schaeffer
  • Kerri Palamara
  • From the Gender Equity in Medicine (GEM) workgroup
Review Paper



Competency-based medical education relies on meaningful resident assessment. Implicit gender bias represents a potential threat to the integrity of resident assessment. We sought to examine the available evidence of the potential for and impact of gender bias in resident assessment in graduate medical education.


A systematic literature review was performed to evaluate the presence and influence of gender bias on resident assessment. We searched Medline and Embase databases to capture relevant articles using a tiered strategy. Review was conducted by two independent, blinded reviewers. We included studies with primary objective of examining the impact of gender on resident assessment in graduate medical education in the USA or Canada published from 1998 to 2018.


Nine studies examined the existence and influence of gender bias in resident assessment and data included rating scores and qualitative comments. Heterogeneity in tools, outcome measures, and methodologic approach precluded meta-analysis. Five of the nine studies reported a difference in outcomes attributed to gender including gender-based differences in traits ascribed to residents, consistency of feedback, and performance measures.


Our review suggests that gender bias poses a potential threat to the integrity of resident assessment in graduate medical education. Future study is warranted to understand how gender bias manifests in resident assessment, impact on learners and approaches to mitigate this bias.


gender bias implicit bias gender assessment evaluation residency training graduate medical education postgraduate medical education 


Compliance with Ethical Standards

Conflict of Interest

The authors declare that they do not have a conflict of interest.


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Copyright information

© Society of General Internal Medicine 2019

Authors and Affiliations

  • Robin Klein
    • 1
    Email author
  • Katherine A. Julian
    • 2
  • Erin D. Snyder
    • 3
  • Jennifer Koch
    • 4
  • Nneka N. Ufere
    • 5
  • Anna Volerman
    • 6
    • 7
  • Ann E. Vandenberg
    • 1
  • Sarah Schaeffer
    • 8
  • Kerri Palamara
    • 9
  • From the Gender Equity in Medicine (GEM) workgroup
  1. 1.Department of Medicine, Division of General Internal Medicine and GeriatricsEmory University School of MedicineAtlantaUSA
  2. 2.Division of General Internal MedicineUniversity of California, San FranciscoSan FranciscoUSA
  3. 3.Department of Medicine, Division of General Internal MedicineUniversity of Alabama Birmingham School of MedicineBirminghamUSA
  4. 4.Department of MedicineUniversity of LouisvilleLouisvilleUSA
  5. 5.Department of Medicine, Division of GastroenterologyMassachusetts General HospitalBostonUSA
  6. 6.Department of MedicineUniversity of ChicagoChicagoUSA
  7. 7.Department of PediatricsUniversity of ChicagoChicagoUSA
  8. 8.Department of Medicine, Division of Hospital MedicineUniversity of California, San FranciscoSan FranciscoUSA
  9. 9.Department of MedicineMassachusetts General HospitalBostonUSA

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