Abstract
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As the authors note, the interactions between faculty and medical students in the setting of a clerkship is transient, without the opportunities, in most circumstances, to develop in-depth mentoring relationships. This study demonstrates that these types of transient interactions are subject to the same type of unconscious biases as any other such brief, relatively superficial interactions. Without additional information with which to work, students—both male and female—unconsciously resort, to some degree, to evaluating their faculty through the lens of gendered expectations. This may help to explain why the differences between male and female faculty were greatest for surgery, which had the highest proportion of male faculty and which is stereotypically thought of as a male profession. However, these stereotypes may be related to women as faculty, in general, as those clerkships with higher proportions of female faculty and traditionally thought of as more female-dominated (pediatrics and obstetrics and gynecology) had similar, but less substantial, differences in faculty evaluations.
Unconscious biases have been noted in all venues. They develop early and strengthen over time, impacted by the culture at large. These biases, which can be positive or negative, result in general perceptions about a group being applied to individuals. They have been identified in both members of the majority (“in”) group, as well as those of the minority (“out”) group. Thus, the similar evaluations of faculty provided by both male and female students in this study. Medical student interactions with faculty would be anticipated to suffer from unconscious bias, as these biases are more likely to be relied upon in situations of ambiguity, multiple competing tasks with limited time, and lack of significant information. The long-standing implicit association of men with work and women with family has resulted in a generalization of traits, with men being expected to be authoritative and competent, while women are expected to be nurturing and sympathetic. 2 Men and women who are seen as not exhibiting these anticipated gendered traits may be subconsciously thought of as different, with the potential to negatively impact evaluations of their performances. This may be one explanation for some of the results in this study.
Among primary areas of diversity impacted by unconscious bias are gender, race/ethnicity, and age. As the authors note, they did not assess for the impact of age on teaching evaluation results. Older faculty may be perceived as more effective teachers or may be seen as leaders; as male faculty tend to be older, the relative impact of faculty gender and age may be intertwined and difficult to separate.
The results of this study are significant. They point to the need for further discussion of unconscious bias with medical students, including how it may impact their evaluations of faculty. That female faculty may receive lower student evaluations also needs to be considered by departments or promotion committees in medical schools. Female faculty are less likely to be promoted, in general, compared with their male counterparts. Although student evaluations are not the sole criterion on which promotion is based, they are considered to varying degrees. They may also impact the likelihood of receiving teaching awards, which can influence promotion. In evaluation of faculty teaching, medical student evaluations should not be used in isolation. As noted in the article, residents have more extensive interactions with faculty, and less gender bias has been noted in their evaluations. Although the number of resident evaluations would be less than those of medical students, significant weight should be given to the former. In addition, consideration should be given to using peer evaluations of medical student didactic teaching to provide additional information regarding faculty teaching abilities.
Although medical students and physicians have received a significant amount of education and training, we are subject to the same unconscious biases as everyone else. This article will hopefully raise awareness of this issue and continue the conversation on addressing unconscious bias in all areas of medicine.