Dangerously Underconfident: Gender and the Cultivation of Professional Role Confidence Emergency Medicine Education

• In Event: 3176 - Sociology of Medical Education

Abstract

This paper examines the role of faculty bias in the reproduction of gender inequalities among emergency medicine (EM) residents. Prior research reveals that significant gender inequality emerges among EM doctors during residency training, but does not fully explain how this inequality is produced. We explore this puzzle by leveraging a longitudinal dataset of 11,737 narrative comments written by 157 attending physicians during real-time direct observations of 202 residents from four accredited training programs attached to university and community hospitals in the United States. A qualitative content analysis of these data reveal differences in how attendings react to male and female residents’ struggles in developing confidence in their new role as practicing physician. Residents experienced trouble with confidence across gender, but under- and overconfident women were evaluated more harshly than their under- and overconfident male colleagues. Attendings described women with problematic confidence as difficult students and unpleasant colleagues who posed risks to patient care. Men with problematic confidence were instead interpreted as having a particular, but acceptable, leadership style and were reassured of their skill and competence. We argue that attending feedback about confidence may cause gendered differences in the development of professional role confidence that could have consequences for persistence in academic medicine. We discuss the implications of our study for medical education and theories of gender inequality.

Authors

• Alexandra E. Brewer, University of Chicago

• Anna S. Mueller, University of Chicago

• Daniel M O'Connor, University of Chicago

• Arjun Dayal, University of Chicago

• Vineet M Arora, University of Chicago