现象:现有文献,以及轶事证据,这表明分层临床分级系统可能显示出系统的人口统计学偏见。本研究旨在深入研究这些潜在的不平等现象。具体来说,这项研究试图解决以下文献中的差距:(1)研究实际分配给学生的成绩(而不是自我报告的),(2)使用8年期间的纵向数据,提供数据的稳定性,(3)重要剖析三个,潜在的混杂协变量,(4)采用综合多元统计设计,(5)不仅调查性别和种族的主要影响,还有他们潜在的互动。方法:参与者包括1,905名毕业生(985名女性,51.7%)在2014年至2021年之间获得医学博士学位。大多数参与者是白人(n=1,310,68.8%),约五分之一是非白人(n=397,20.8%)。没有报告的种族数据为10.4%(n=198)。为了探索潜在的差异分级,采用协方差的双向多变量分析来检查种族和性别对八个必需的职员等级的影响,根据先前的学习成绩进行调整。研究结果:有两个显著的主要影响,种族和性别,但性别和种族之间没有交互作用。女性在所有八个职员中平均获得更高的等级,白人学生在八个职员中的四个平均成绩较高(医学,儿科,手术,产科/妇科)。即使考虑到先前的性能协变量,这些关系也保持不变。见解:这些发现提供了额外的证据,表明分级系统可能会受到系统的人口统计学偏见的影响。很难区分各种因素对所观察到的性别和种族差异的贡献,产生这些偏见的相互作用可能非常复杂。切断分级偏差的缠结网的最简单解决方案可能是完全远离分层分级系统。
Phenomenon: Existing literature, as well as anecdotal evidence, suggests that tiered clinical grading systems may display systematic demographic biases. This study aimed to investigate these potential inequities in-depth. Specifically, this study attempted to address the following gaps in the literature: (1) studying grades actually assigned to students (as opposed to self-reported ones), (2) using longitudinal data over an 8-year period, providing stability of data, (3) analyzing three important, potentially confounding covariates, (4) using a comprehensive multivariate statistical design, and (5) investigating not just the main effects of gender and race, but also their potential interaction. Approach: Participants included 1,905 graduates (985 women, 51.7%) who received the Doctor of Medicine degree between 2014 and 2021. Most of the participants were white (n = 1,310, 68.8%) and about one-fifth were nonwhite (n = 397, 20.8%). There were no reported race data for 10.4% (n = 198). To explore potential differential grading, a two-way multivariate analysis of covariance was employed to examine the impact of race and gender on grades in eight required
clerkships, adjusting for prior academic performance. Findings: There were two significant main effects, race and gender, but no interaction effect between gender and race. Women received higher grades on average on all eight
clerkships, and white students received higher grades on average on four of the eight
clerkships (Medicine, Pediatrics, Surgery, Obstetrics/Gynecology). These relationships held even when accounting for prior performance covariates. Insights: These findings provide additional evidence that tiered grading systems may be subject to systematic demographic biases. It is difficult to tease apart the contributions of various factors to the observed differences in gender and race on clerkship grades, and the interactions that produce these biases may be quite complex. The simplest solution to cut through the tangled web of grading biases may be to move away from a tiered grading system altogether.