347 Sex Evaluation and Numeric Distribution in Emergency Medicine Residencies

Abstract

While females make up more than half of medical school matriculants, they only comprise about one-third of emergency medicine residents. We sought to determine to what extent emergency medicine residents feel that sex distribution within a program is an influential factor in 1) choosing a residency program and 2) perceived quality of education. We identified 171 accredited emergency medicine residency programs in the United States with cohorts entering between 2014-2017. We emailed programs to confirm accuracy of publicly available data collected from program Web sites. A prospective, cross-sectional, online survey was used to determine which factors influenced residents’ decisions in creating rank lists as fourth-year medical students and had a perceived effect on residency education. Of the 171 programs, 143 (83.6%) had publicly available data on resident and program leadership and were included. Of 5,211 residents, 3,371 (64.7%) were male and 1840 (35.3%) were female. The overall male to female ratio was 1.83:1. Individual program ratios ranged from 0.85-8.0. Only 8 (5.6%) had a female-predominant ratio. Surveys were sent to 758 residents in 17 programs, and 138 responded (18% response rate). The most important factors in making rank lists were: location (97%), experience at the program (96%), and personality of the residents in the program (96%). Factors related to sex showed influence on rank lists in: sex of residents (39.9%; 95% CI: 31.6%-48.5%); sex of attending physicians (30.4%; 95% CI: 22.9%-38.8%), and sex of program director and assistant program directors (23.9%; 95% CI: 17.1%-31.1%). Sex composition of residents was more important than sex composition of program directors (p=0.004). The least important factors to affect residency education were: program length, program reputation, and compensation. Personality of residents had the highest median Likert scale score. Factors related to sex affecting education followed an identical pattern as in creating rank lists. Using >50%, >60%, >70%, >80%, or >90% to describe a faculty or residency as male or female predominant, respondents had a broader interquartile range for considering female predominance (>50% to >70%) compared to male predominance (>60% to >70%). When responses were stratified by sex, female residents placed higher importance on subcategories specifically related to sex (Table 1). Surveys to quantify the importance of sex in residency selection showed that other factors such as location, personality of residents, and educational experiences were rated as much more important than sex differences within a program. However, factors influencing rank list creation and residency education differ in perceived importance depending on whether the resident is male or female.Table 1Statistically significant responses stratified by sex.QuestionFemaleMaleP-valueYesNoYesNoFactors influencing rank listExperience on interview day810515.006Patient demographics67143719.025Sex composition of residents43381244.000Sex of PD and APDs2754650.002Sex of attending physicians3447749.000Ethnic diversity of fellow residents39421739.037Factors affecting residency educationSex of PD and APDs45351541.001Sex of attending physicians50302333.014Ethnic diversity of PD and APDs44361838.008Pearson chi-square tests, degrees of freedom = 1. Open table in a new tab