Racial Bias in Evaluation of Trainees in Obstetrics and Gynecology: A Scoping Review

Racial bias in medical education can affect objective assessment of medical students and residents, especially those who have been historically minoritized and underrepresented in medicine (URM). This scoping review examines the impact of racial bias in evaluation of trainees in Obstetrics and Gynecology (OB/GYN) by mapping the existing literature regarding both racial bias in evaluation and interventions aimed to decrease such bias.

The review was registered and conducted with the Open Science Framework. Comprehensive search identified U.S. studies published through April 2025 that evaluated racial bias in the assessment of trainees in OB/GYN and interventions aimed at reducing bias. Databases searched included PubMed, CINAHL, Education Full Text, Embase, ERIC, and Scopus; references and citations of included studies were also reviewed.

References were included if they described racial bias in any form of clinical evaluation, assessment of medical knowledge or performance of OB/GYN medical students, residents or fellows, or if they explored strategies to eliminate such bias. References that were narrative, literature review, or contained no data were excluded.

Of 1469 studies screened, fifty-nine underwent full-text review, and 16 met inclusion criteria. Three studies analyzed biased linguistic differences in recommendation letters and evaluations. Two studies examined clinical exposure, both finding that minoritized trainees had fewer procedures and hands-on experiences. Nine studies focused on clerkship/clinical grading and evaluations, with 8 reporting lower evaluations for URM students. One found no disparity in objective standardized clinical exam scores by race. Two studies found bias in application and matriculation to OB/GYN residency and fellowship. Fourteen studies proposed recommendations to address disparities; only 1 evaluated implementation, with the evaluated intervention not improving inequity.

Racial bias in assessment of OB/GYN medical students and residents consistently shows negative impacts on historically minoritized trainees. Current literature inadequately addresses effective strategies to mitigate this bias. Future research should prioritize developing and testing targeted interventions aimed at reducing disparities and creating evidence-based institutional policies to ensure equity.