Exploring Gender, Race, and Ethnicity Differences in Assessment of Pediatric Subspecialty Fellows Using the...

Area of Science:

• Medical Education
• Health Professions Training
• Pediatrics

Background:

• Trainee assessments in medical specialties can exhibit gender and racial/ethnic biases.
• The Entrustable Professional Activity (EPA) framework assesses professional activities and requires assigning supervision levels.
• Potential biases in EPA-based assessments among pediatric subspecialty fellows warrant investigation.

Purpose of the Study:

• To analyze Clinical Competency Committee (CCC)-assigned EPA supervision levels for gender and race/ethnicity differences.
• To investigate potential biases in EPA-based assessments within pediatric subspecialty training.

Main Methods:

• Secondary analysis of de-identified datasets from pediatric subspecialty fellows (2018-2022).
• CCCs assigned supervision levels for Pediatric Subspecialty EPAs.
• Data were linked to fellow demographics (gender, race/ethnicity), categorizing race/ethnicity as underrepresented in medicine, Asian, or White.
• Ordinal mixed effects models analyzed supervision ratings, adjusting for covariates and clustering.

Main Results:

• Data from 561 fellows were analyzed.
• Asian fellows received lower supervision levels for the Consultation EPA compared to White fellows (aOR 0.48, 95% CI: 0.31-0.77).
• No other significant differences in EPA supervision levels were observed based on gender or other racial/ethnic categories.

Conclusions:

• EPA-based assessments in pediatric subspecialty fellows showed no gender bias.
• A single instance of racial bias was identified, affecting Asian fellows regarding the Consultation EPA.
• Findings suggest EPA-based assessments are largely unbiased, which is reassuring given their increasing use in medical education.