Bias in Surgical Residency Evaluations: A Scoping Review

OBJECTIVE: Given widespread disparities in the surgical workforce and the advent of competency-based training models that rely on objective evaluations of resident per-formance, this review aims to describe the landscape of bias in the evaluation methods of residents in surgical training programs in the United States.DESIGN: A scoping review was conducted within PubMed, Embase, Web of Science, and ERIC in May 2022, without a date restriction. Studies were screened and reviewed in duplicate by 3 reviewers. Data were described descriptively. SETTING/PARTICIPANTS: English-language studies con-ducted in the United States that assessed bias in the eval-uation of surgical residents were included.RESULTS: The search yielded 1641 studies, of which 53 met inclusion criteria. Of the included studies, 26 (49.1%) were retrospective cohort studies, 25 (47.2%) were cross-sectional studies, and 2 (3.8%) were prospective cohort studies. The majority included general surgery residents (n = 30, 56.6%) and nonstandardized examination modali-ties (n = 38, 71.7%), such as video-based skills evaluations (n = 5, 13.2%). The most common performance metric evaluated was operative skill (n = 22, 41.5%). Overall, the majority of studies demonstrated bias (n = 38, 73.6%) and most investigated gender bias (n = 46, 86.8%). Most stud-ies reported disadvantages for female trainees regarding standardized examinations (80.0%), self-evaluations (73.7%), and program-level evaluations (71.4%). Four stud-ies (7.6%) assessed racial bias, of which all reported disad-vantages for trainees underrepresented in surgery.CONCLUSIONS: Evaluation methods for surgery resi-dents may be prone to bias, particularly with regard to female trainees. Research is warranted regarding other implicit and explicit biases, such as racial bias, as well as for nongeneral surgery subspecialties. ( J Surg Ed 80:922-947.& COPY; 2023 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.)