P3.159: Unrecognized Bias: Gender, Ethnic and Racial Disparities in Recognition Among Medical Residents

Background: Gender, racial, and ethnic biases in formal evaluations have been well-documented in medical education and may have long-standing impacts on career trajectory. For instance, female residents in surgical programs are less likely to receive awards than their male counterparts and medical students who are Underrepresented in Medicine (URiM) are less likely to be selected for membership to honors societies. However, potential disparities in informal recognition, such as “shout-outs” or “kudos,” among residents remain understudied. Bias in recognition may perpetuate disparities in medical education. This study explores whether there are gender, racial, or ethnic differences in shout-outs among residents in Yale New Haven Hospital’s Internal Medicine (Primary Care and Traditional), Pediatrics, and Combined Internal Medicine and Pediatrics programs.

Methods: Weekly “shout-outs” sent by chief residents via email to the residency programs from 2019 to 2024 were analyzed. These anonymous nominations from residents, nurses, faculty, and staff recognized exceptional behavior or contributions. To ensure privacy, an “honest broker” matched de-identified shout-out data with self-reported demographic records from the Graduate Medical Education Office. Research assistants independently coded the shout-outs and identified common themes. Chi-squared and Fisher’s exact tests assessed differences in recognition across gender, race, and ethnicity.

Results: A total of 1,407 shout-outs were received by 381 residents: 235 (62%) female, 146 (38%) male, 97 (25%) Asian, 96 (25%) URiM (Black/African American or Hispanic), 179 (47%) White, and 9 (3%) preferred not to specify race/ethnicity. For example, one shout-out read: “Outstanding job leading a code—she created a calm environment and fostered collaboration.”

Females were twice as likely to receive shout-outs compared to males (95% CI [1.78, 2.10], p< 0.001). There was no significant difference in the number of shout-outs received by White and URiM residents overall. However, White residents were 2.3 times more likely to be recognized for leadership (95% CI [0.18-0.96], p< 0.02) and 2.4 times more likely to be recognized for academic achievement (95% CI [0.16-0.48], p< 0.01). Black residents were primarily recognized for patient care and team collaboration, with no significant difference compared to White residents. Asian residents were three times less likely to be recognized for leadership (95% CI [0.17-0.61], p< 0.001) and four times less likely to be recognized for academic achievement (95% CI [0.15-0.59], p< 0.001) than White residents. Hispanic residents were 3.8 times less likely to be recognized for leadership (95% CI [0.15-0.70], p< 0.001) than White residents.

Conclusion: Although URiM and Asian residents received shout-outs in proportion to their group size, significant differences existed in recognition categories. These disparities may impact career advancement, mentorship, and long-term professional growth, potentially perpetuating inequities in medicine. Addressing these disparities is crucial to promoting inclusive recognition practices and ensuring all residents can thrive, regardless of gender, race, or ethnicity.