A professor of medicine and director of the internal medicine residency program in the UofL School of Medicine, Dr. Jennifer Koch is a member of the Gender Equity in Medicine (GEM) research group, a collaboration of medical educators from multiple universities working together to better understand the impact of gender bias in medical training.

In September, the American Medical Association, the AMA Women Physicians Section (WPS) and the AMA Foundation awarded a $10,000 grant to the group as part of the 2021 Joan F. Giambalvo Fund for the Advancement of Women research grants program.

The group received the grant for a multi-site longitudinal study aimed at understanding the combined impact of race, ethnicity and gender on women’s experiences in graduate medical education, also known as medical residency. UofL News talked to Koch about why this work is important and how it will help ensure quality medical care for all.

UofL News: What have you and the group learned in your study of gender bias in graduate medical education?

Jennifer Koch: We have learned that there are differences based on gender in the assessment of learners (resident doctors) in internal medicine residency. Whereas residents who are men tend to receive performance scores that increase throughout their training as they gain experience, women residents are more likely to see a plateau in the performance scores they receive when they reach the halfway point in residency.

There is evidence that women doctors who are out in practice have better patient outcomes, which suggests that it is highly unlikely that the differences in assessment scores during residency represent a true difference in their performance during training. Therefore, this difference likely indicates the presence of gender bias in the educational experience of women residents.

ULN: What might the implications be on health care?

Koch: A diverse health care workforce is essential to delivering excellent patient care to a diverse population. Working to mitigate bias in the training of physicians is an important step toward promoting a diverse physician workforce.

ULN: How might this bias be reduced?

Koch: This requires more study. Some ways we might accomplish this include implicit bias training and raising awareness amongst faculty evaluators and revamping assessment tools which may inadvertently promote bias.

ULN: What inspired you to dig deeper into this issue?

Koch: I drew on my own experiences as a woman in medicine, as well as my desire to provide an excellent training experience for the physicians in my internal medicine residency training program.

I have a very specific memory as a resident when I was attempting a difficult procedure and the situation was a critical one. My attending barked at me to allow the male resident to step in to do the procedure instead. I said, ‘No, I’ve got this!’ – and I did. I successfully completed the procedure. 

This is an example of how bias can affect patient care. In the middle of a critical situation where I was trying to fully focus on the patient, I had to remove my focus from the patient and make a split-second decision about whether to stand up for myself. Most examples are, thankfully, not this dramatic. But every experience a trainee has helps to shape them into their future self as a physician.

ULN: Regarding the new funding, what do you hope to learn about gender and ethnicity or race in assessments of residents?

Koch: We hope to quantitate the degree to which race-based bias is present in assessment of these learners and examine whether it exists in synergy with gender bias for those trainees who are both women and underrepresented in medicine. Quantifying its extent is a first step toward better defining the potential problem and then working toward its mitigation.

ULN: What have you learned from this research that you have applied at UofL to increase equity for female residents?

Koch: We have created a Women In Medicine Networking group (WIMN) in the UofL internal medicine residency program. The group holds educational sessions and discussions about issues experienced by women in the field of medicine and as COVID allows, holds social events to encourage networking and mentorship amongst women residents and faculty.