July 01, 2019 - Research

Published: Is there evidence of gender bias in the oral examination for initial certification by the American Board of Physical Medicine and Rehabilitation?

Summary by Sherilyn W Driscoll, MD

Unconscious bias is a real and well-documented phenomenon. It can result in prejudicial evaluation of another person and lead to unfair treatment. Initial certification in PM&R by the ABPMR includes an oral examination (Part II). Given that the Part II Examination is administered to humans by humans, each with their own unconscious biases, is it possible that gender bias affects scoring? It is critically important to the board that the certification processes are as free of bias as possible.

We undertook a retrospective observational study of first-time Part II Examination test takers between 2013 and 2018. We queried whether performance on the exam differed based on candidate gender or configuration of examiner/candidate gender pairings (male examiner with male versus female examinee, for example). Prior to this study, we had already implemented examiner unconscious bias training. We assessed if that training had any impact on examiner or candidate performance.

Test results significantly differed between men and women with an 84% pass rate for men and an 89% pass rate for women. Mean scaled scores were also significantly different for men (6.56) and women (6.81; P < 0.001). The biggest domain score differences were seen in the areas of data acquisition and interpersonal and communication skills. Although there was some variation in comparisons of candidate domain performance by examiner and candidate gender combination, the female examinees scored higher than male examinees whether their examiner was male or female. The implementation of examiner unconscious bias training did not impact examiner or candidate performance.

Women and men do equally well on the Part I (written) Examination such that a difference in knowledge base does not explain the Part II score difference. In a brief review of the literature, we learned that other studies also support the idea that women outscore men in various face-to-face examinations, and possible explanations are offered. This difference does not seem to be due to scoring gender bias by the Part II examiners.

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Is there evidence of gender bias in the oral examination for initial certification by the American Board of Physical Medicine and Rehabilitation?

Driscoll SW, Robinson LR, Raddatz MM, Kinney CL. Is there evidence of gender bias in the oral examination for initial certification by the American Board of Physical Medicine and Rehabilitation? American Journal of Physical Medicine & Rehabilitation. 2019. doi: 10.1097/PHM.0000000000001126