Clinical Performance Evaluations of Third-Year Medical Students and Association With Student and Evaluator Gender

Abstract

Purpose:
Clinical performance evaluations are major components of medical school clerkship grades. But are they sufficiently objective? This study aimed to determine whether student and evaluator gender is associated with assessment of overall clinical performance.

Method:
This was a retrospective analysis of 4,272 core clerkship clinical performance evaluations by 829 evaluators of 155 third-year students, within the Alpert Medical School grading database for the 2013-2014 academic year. Overall clinical performance, assessed on a three-point scale (meets expectations, above expectations, exceptional), was extracted from each evaluation, as well as evaluator gender, age, training level, department, student gender and age, and length of observation time. Hierarchical ordinal regression modeling was conducted to account for clustering of evaluations.

Results:
Female students were more likely to receive a better grade than males (adjusted odds ratio [AOR] 1.30, 95% confidence interval [CI] 1.13-1.50), and female evaluators awarded lower grades than males (AOR 0.72, 95% CI 0.55-0.93), adjusting for department, observation time, and student and evaluator age. The interaction between student and evaluator gender was significant (P = .03), with female evaluators assigning higher grades to female students, while male evaluators' grading did not differ by student gender. Students who spent a short time with evaluators were also more likely to get a lower grade.

Conclusions:
A one-year examination of all third-year clerkship clinical performance evaluations at a single institution revealed that male and female evaluators rated male and female students differently, even when accounting for other measured variables.

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Academic Medicine, Vol. 92, No. 6 / June 2017 835
Research Report
Selection of graduating medical
students into residency programs is
driven by multiple factors. However,
according to program directors, the most
important selection criteria are students’
grades on required core clerkships.1
Clinical performance evaluations (CPEs)
are used in most core clinical clerkships as
assessment and grading tools for medical
students. Clinicians who work with
medical students are asked to complete
formal evaluations of each student’s
basic clinical skills, such as history taking
and case presentation, as well as fund of
knowledge and professionalism. In most
clerkships, these evaluations, along with
standardized written examinations and
objective structured clinical examinations
(OSCEs), provide the data from which
students’ final clerkship grades are
determined. Studies show that these
CPEs are weighted more heavily than the
other evaluation methods, accounting for
50% to 70% of the final grade across all
clerkships.2,3 Despite the importance of
core clerkship clinical evaluations, there
is a paucity of literature examining the
degree of objectivity of this measure.4
The numerous evaluations that
occur over the course of attaining
entrance to medical school and
during the preclinical years are largely
standardized and unlikely to exhibit
grader-dependent bias. In contrast,
medical students are evaluated in a
more subjective manner when being
assessed on their clinical performance.
For that reason, the association of
grading with gender and the gender
pairing of trainer and trainee is
important, yet these factors are not well
understood in the medical setting in
areas where subjectivity of grading is
high. Literature from the education field
has shown that student gender often
plays a role in how students are treated
and graded.5,6 In primary schools, girls
are awarded better grades than boys,
despite similar test scores, which some
researchers attribute to “noncognitive
skills”—specifically, “a more
developed attitude towards learning.”6
Additionally, teachers’ gender can affect
their expectations and perceptions
of educational competence and
performance.7,8 Furthermore, studies9–11
suggest that gender pairing can
enhance, through a “role-model effect,”
student engagement and behavior, or,
conversely, gender noncongruence may
induce “stereotype threat,” in which
anxiety that one will confirm a negative
stereotype can lead to a decrement in
performance.
A few small studies12–14 have suggested
an interaction between student and
evaluator gender in the grading of
medical students’ simulated clinical
performance on OSCEs by standardized
patients (SPs). One small study of OSCE
grading13 found that male and female
medical students fared similarly overall;
however, when graded solely by female
SPs, women scored significantly higher,
yet male and female students were rated
the same by male SPs. These findings
were replicated in a more recent study
of OSCE grading,14 which specifically
Abstract
Purpose
Clinical performance evaluations are
major components of medical school
clerkship grades. But are they sufficiently
objective? This study aimed to determine
whether student and evaluator gender
is associated with assessment of overall
clinical performance.
Method
This was a retrospective analysis
of 4,272 core clerkship clinical
performance evaluations by 829
evaluators of 155 third-year students,
within the Alpert Medical School
grading database for the 2013–2014
academic year. Overall clinical
performance, assessed on a
three-point scale (meets expectations,
above expectations, exceptional), was
extracted from each evaluation, as
well as evaluator gender, age, training
level, department, student gender and
age, and length of observation time.
Hierarchical ordinal regression modeling
was conducted to account for clustering
of evaluations.
Results
Female students were more likely to
receive a better grade than males
(adjusted odds ratio [AOR] 1.30, 95%
confidence interval [CI] 1.13–1.50),
and female evaluators awarded lower
grades than males (AOR 0.72, 95% CI
0.55–0.93), adjusting for department,
observation time, and student and
evaluator age. The interaction between
student and evaluator gender was
significant (P = .03), with female
evaluators assigning higher grades
to female students, while male
evaluators’ grading did not differ by
student gender. Students who spent a
short time with evaluators were also
more likely to get a lower grade.
Conclusions
A one-year examination of all third-year
clerkship clinical performance evaluations
at a single institution revealed that male
and female evaluators rated male and
female students differently, even when
accounting for other measured variables.
Acad Med. 2017;92:835–840.
First published online January 17, 2017
doi: 10.1097/ACM.0000000000001565
Please see the end of this article for information
about the authors.
Correspondence should be addressed to Alison
Riese, Department of Pediatrics, Alpert Medical
School, Hasbro Children’s Hospital, 593 Eddy St.,
Providence, RI 02903; telephone: (401) 444-8531;
e-mail: ariese@lifespan.org.
Clinical Performance Evaluations of Third-Year
Medical Students and Association With
Student and Evaluator Gender
Alison Riese, MD, MPH, Leah Rappaport, MD, Brian Alverson, MD,
Sangshin Park, DVM, MPH, PhD, and Randal M. Rockney, MD

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Research Report
Academic Medicine, Vol. 92, No. 6 / June 2017
836
examined the gender interaction during
a “gender-sensitive” patient situation, the
examination of the chest.
Similar disparities in grading regarding
student and evaluator gender have
been found in a few small studies of
nonsimulated clinical settings.15,16 A
small study of students completing a
required one-month ambulatory care
medicine clerkship at the Medical
College of Wisconsin16 showed that the
highest mean grade was given by male
preceptors to female students, and the
lowest mean grade was given by female
preceptors to male students. In a study
of evaluations of internal medicine
residents, male residents received higher
grades from male attendings than from
female attendings.17 Conversely, a study
of medical student grading in obstetrics–
gynecology18 found that female students
performed better on written exams
and OSCEs; however, they were graded
similarly to male students by their faculty
evaluators.
The influence of gender on grading
in the clinical setting is important to
understand, considering the highly
subjective nature of clinical evaluations
compared with multiple-choice tests,
where gender has no bearing on
grade assignment, as well as the more
structured setting of OSCEs, where
graders are generally well trained and
have more uniform interactions with
the students being assessed. CPEs are
completed by evaluators of all training
levels, who interact with students in
various types of settings and over varying
durations, yet their assessments are
weighted heavily in clerkship grading.
As a first step in any effort to increase
objectivity in clinical grade assignment,
it is necessary to fully understand what
issues influence evaluators’ grading of
student clinical performance. There has
been no study examining third-year
core clerkships as a whole to see how the
gender of the evaluator and the gender
of the student may be associated with
differences in the clinical evaluation of
the student. We carried out this study
to determine whether student and
evaluator gender is associated with the
grades assigned. Secondarily, we sought
to explore other student and evaluator
factors that may be associated with
variance in grading.
Method
This was a retrospective study conducted
at the Alpert Medical School (AMS).
All 4,462 CPEs recorded in the medical
school’s grading database (OASIS) from
third-year core clerkships during the
2013–2014 academic year were initially
included. At AMS, the core clerkships
and their duration during the study
period consisted of internal medicine
(12 weeks) and surgery, obstetrics–
gynecology, family medicine, pediatrics,
and psychiatry (each 6 weeks). The
medical school’s administrative offices
compiled deidentified demographic
information about the student and
evaluator for each CPE and assigned
an ID number for each student and
each evaluator who was involved in
the CPEs being studied. The evaluator
IDs were used to account for nesting of
evaluations among evaluators—that is,
cases where evaluators assessed more
than one student. As the indicator of the
student’s global clinical performance, the
“overall clinical performance” grade on
the CPE, which from now on we refer to
as the student grade, was extracted from
each CPE. The possible grades that could
be selected by each evaluator completing
a CPE were “exceptional,” “above
expectations,” “meets expectations,” and
“below expectations.” An evaluation was
excluded if it was noted to be a duplicate
entry or if data were incomplete for the
primary outcome or predictor variables.
Additionally, CPEs with a grade of
“below expectations” were excluded
because of the rare occurrence (< 1%) of
this grade.
Because we were provided deidentified
data, we were not able to match those
data with any objective nonclinical
evaluations. However, we did compare
the United States Medical Licensing
Examination (USMLE) Step 1 scores
for men versus women in the class of
2015. The medical school administrative
offices provided the means and standard
deviations (SDs) of the USMLE Step 1
scores for the male and female students in
that class, since these students’ CPE data
were in our study. The means and SDs for
these two groups were compared using
Student t test. This study was declared
exempt by the Lifespan institutional
review board. (Lifespan Corporation,
Rhode Island’s largest health system,
is affiliated with the AMS of Brown
University.)
For each CPE, the dataset contained
demographic information about the
clerkship context, the student, and the
evaluator. Clerkship characteristics for
each CPE consisted of the clerkship
department and the length of observation
time for the student/evaluator (either
< 2 half-days or ≥ 2 half-days). Student
demographic information included
student gender and age (grouped as
25–27 years old and ≥ 28 years old).
Evaluator variables were evaluator gender,
Table 1
Demographic Information Regarding
the Third-Year Medical Students and
Their Evaluators at Alpert Medical
School, 2013 to 2014a
Characteristic No. (%)
Students (n = 155)
Gender
Male 76 (49.0)
Female 79 (51.0)
Age quartile
25–26 years 49 (33.3)
27 years 36 (24.5)
28 years 27 (18.4)
> 28 years 35 (23.8)
Evaluators (n = 829)
Gender
Male 399 (48.1)
Female 430 (51.9)
Age quartile
25–30 years 290 (37.8)
31–40 years 210 (27.4)
41–50 years 137 (17.9)
> 50 years 130 (17.0)
Training level
Resident (PGY 1) 168 (22.3)
Resident (PGY 2) 89 (11.8)
Resident (PGY 3–5) 155 (20.6)
Attending 342 (45.4)
Department
Family medicine 126 (15.2)
Psychiatry 50 (6.0)
Internal medicine 336 (40.5)
Obstetrics–
gynecology
47 (5.7)
Pediatrics 155 (18.7)
Surgery 115 (13.9)
Abbreviation: PGY indicates postgraduate year.
aThe authors carried out a retrospective analysis
of 4,272 third-year clerkship clinical performance
evaluations, involving the evaluators and the students
whose data are in this table, to determine whether
student and evaluator gender are associated with
assessment of overall clinical performance.

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Research Report
Academic Medicine, Vol. 92, No. 6 / June 2017 837
age (in quartiles), and training level
(residency year or attending).
All statistical analyses were performed
using SAS 9.4 (SAS Institute, Cary,
North Carolina). A P value < .05 was
considered to be statistically significant.
This study examined the associations of
final grade with gender and covariates
using chi-square tests. Hierarchical
ordinal regression modeling was
conducted to examine the effects of
student and evaluator characteristics on
a student’s grade (“exceptional,” “above
expectations,” or “meets expectations”),
adjusting for nonindependence, or
“clustering,” of evaluators who rated
more than one student. Gender and
covariates with a P value < .05 in the
univariable model were incorporated
into a multivariable regression model,
which was built by the stepwise
selection procedure. Variables that
significantly reduced residual variance
were retained in the final model. To
avoid colinearity, phi coefficients were
estimated for two independent variables.
If high colinearity among variables was
observed (r > 0.6), we selected the most
relevant variable to the student’s grade
for multivariable modeling. Because
of the small number of evaluations in
family medicine and psychiatry, data
from these specialties were combined
for the multivariable modeling. After the
main effects model was built, interaction
terms were explored for significance.
Results
Of the 4,462 CPEs initially included in
this study, 190 (0.043%) were excluded.
Thirty-eight were excluded because they
were duplicates, and 136 were excluded
because of missing values in predictors
of interest (student or evaluator gender;
no. = 18) or in the outcome of interest
(grade; no. = 118). In addition, 16 CPEs
were excluded because of a “below
expectations” grade. Thus, the final
study dataset comprised 4,272 CPEs,
which were completed by 829 evaluators
regarding the performance of 155
students. The mean (SD) USMLE Step
1 score for the AMS class of 2015 was
221 (18.70) for women and 231 (18.98)
for men (P = .0083). The median age
of students was 27 years (interquartile
range [IQR] 26–28 years); the median
age of evaluators was 33 years (IQR
29–45 years). (See Table 1 for student
and evaluator demographics.) While the
number of students rotating through
each clerkship was consistent, the number
of CPEs for each student varied by
clerkship. The internal medicine clerkship
evaluators completed 1,267 CPEs
(30% of all CPEs), and the pediatrics
clerkship evaluators completed 1,154
(27%), which means that these two
clerkships contributed a large percentage
of CPEs compared with the percentages
contributed by the other four clerkships.
There was variability in the number
of CPEs per student (median 27, IQR
6–39) and CPEs per evaluator (median
3, IQR 1–7). Each clerkship, student, and
evaluator characteristic examined was
associated with a statistically significant
difference in the distribution of grades
received. (See Table 2.)
In univariable models, all predictors
were associated with the grade. Because
of high correlation between faculty age
Table 2
Associations of Third-Year Clinical Performance Grades With Clerkship, Student, and
Evaluator Characteristics, Alpert Medical School, 2013 to 2014a
Characteristic
No. (%) of
all clinical
evaluations
(n = 4,272)
No. (%) of grades by category
P
value
Meets
expectations
(n =721)
Above
expectations
(n = 1,826)
Exceptional
(n = 1,725)
Clerkships
Department
Obstetrics–gynecology 602 (14.1) 136 (22.6) 271 (45.0) 195 (32.4) < .001
Pediatrics 1,154 (27.0) 236 (20.5) 483 (41.9) 435 (37.7)
Psychiatry 300 (7.0) 45 (15.0) 136 (45.3) 119 (39.7)
Family medicine 369 (8.6) 52 (14.1) 158 (42.8) 159 (43.1)
Surgery 580 (13.6) 68 (11.7) 268 (46.2) 244 (42.1)
Internal medicine 1,267 (29.7) 184 (14.5) 510 (40.3) 573 (45.2)
Observation time
≤ 2 half-days 505 (11.8) 143 (28.4) 261 (51.8) 100 (19.8) < .001
> 2 half-days 3,785 (88.2) 578 (15.3) 1,565 (41.5) 1,625 (43.1)
Students
Gender
Male 2,036 (47.7) 381 (18.7) 857 (42.1) 798 (39.2) .009
Female 2,236 (52.3) 340 (15.2) 969 (43.3) 927 (41.5)
Age
25–27 years 2,542 (63.7) 482 (19.0) 1,091 (42.9) 969 (38.1) < .001
≥ 28 years 1,448 (36.3) 211 (14.6) 617 (42.6) 620 (42.8)
Evaluators
Gender
Male 2,081 (48.7) 263 (12.6) 893 (42.9) 925 (44.5) < .001
Female 2,191 (51.3) 458 (20.9) 933 (42.6) 800 (36.5)
Age quartile
25–30 years 1,671 (41.2) 300 (18.0) 659 (39.4) 712 (42.6) < .001
31–40 years 1,111 (27.4) 193 (17.4) 450 (40.5) 468 (42.1)
41–50 years 701 (17.3) 88 (12.6) 325 (46.4) 288 (41.1)
≥ 51 years 573 (14.1) 93 (16.2) 276 (48.2) 204 (35.6)
Training level
Resident (PGY 1) 763 (18.8) 115 (15.1) 281 (36.8) 367 (48.1) < .001
Resident (PGY 2) 647 (15.9) 94 (14.5) 278 (43.0) 275 (42.5)
Resident (PGY 3–5) 883 (21.7) 179 (20.3) 350 (39.6) 354 (40.1)
Attending 1,776 (43.7) 287 (16.2) 826 (46.5) 663 (37.3)
Abbreviation: PGY indicates postgraduate year.
aThe authors carried out a retrospective analysis of 4,272 third-year clerkship clinical performance evaluations
by 829 evaluators of 155 students to determine whether student and evaluator gender are associated with
assessment of overall clinical performance.

Copyright © by the Association of American Medical Colleges. Unauthorized reproduction of this article is prohibited.
Research Report
Academic Medicine, Vol. 92, No. 6 / June 2017
838
and training level (phi coefficient 0.84),
only evaluator age was considered for the
multivariable model. A total of 32.9% of the
variability in the grades was accounted for
by within-evaluator nesting of grades in the
multivariable model (intraclass correlation
coefficient = 0.329; P < .001). All significant
differences in the univariable models were
retained in the multivariable model. In the
multivariable model, female student gender
was associated with higher grades (adjusted
odds ratio [AOR], 1.30; 95% CI, 1.13–1.50).
Female faculty gender was associated
with lower grades (AOR, 0.72; 95% CI,
0.55–0.93). Longer observation time, older
student age, and younger evaluator age were
all associated with higher grades. Evaluators
in internal medicine had the highest odds
of giving a better grade, while those in
obstetrics–gynecology had the lowest odds.
(See Table 3.)
The interaction between student and faculty
gender, adjusted for all other main effects,
was also significant (P = .03; see Figure 1).
Male evaluators did not significantly differ
in their grading of male and female students
(P = .29); however, female evaluators
gave lower grades to male students
compared with female students (P < .001).
Additionally, a significant interaction
between faculty age and faculty gender was
found (P = .047), with older male evaluators
giving significantly lower grades than
younger men (P = .001), while there was
no significant difference in grading for the
female age groups (P = .71). (See Figure 2).
There was no interaction between student
gender and student age (P = .63).
Discussion
In one year at a large U.S. medical school,
there were over 4,000 CPEs of students
in core clerkships, and data revealed
that in clerkship grading, overall, male
students received lower grades than female
students on their CPEs. This finding is
in accordance with literature examining
gender differences in clinical performance.
In general, male and female medical
students perform similarly on the MCAT
exam and have similar preclinical GPAs
and USLME tests scores,15,19,20 albeit with
factors including content area and student
and school characteristics playing a role
in performance. The class of students
represented in our dataset actually differed
in their performance on USMLE Step 1,
with men performing significantly better.
In contrast, other studies15,21 suggest
that female medical students do tend
to perform better on OSCEs, including
those that are part of the USMLE Step
2 Clinical Skills (CS) exam, and receive
better evaluations on their actual clinical
performance. There was no interaction
between evaluator gender and student
gender found in the study of Step 2 CS
scoring.21 However, our findings show that
the discrepancy in clinical performance
grades between male and female medical
students was driven primarily by female
evaluators.
The discrepancy between male and
female evaluators’ assessment of medical
Table 3
Odds Ratios of Receiving a Higher Grade—by Clerkship, Student, and Evaluator
Characteristics—on 4,272 Third-Year Clerkship Clinical Performance Evaluations,
Alpert Medical School, 2013 to 2014a,b
Characteristic
Univariable model Multivariable model
OR (95% CI) P value AOR (95% CI) P value
Clerkships
Department
Obstetrics–gynecology 1.00c< .001 1.00c.002
Pediatrics 1.11 (0.67–1.83) 0.83 (0.49–1.40)
Family medicine and psychiatryd1.52 (0.91–2.53) 1.24 (0.71–2.17)
Surgery 1.88 (1.10–3.21) 1.31 (0.74–2.33)
Internal medicine 2.09 (1.30–3.36) 1.61 (0.97–2.69)
Observation time
≤ 2 half-days 1.00c< .001 1.00c< .001
> 2 half-days 2.72 (2.20–3.38) 2.74 (2.17–3.46)
Students
Gender
Male 1.00c.016 1.00c.026
Female 1.17 (1.03–1.33) 1.30 (1.13–1.50)
Age group
25–27 years 1.00c< .001 1.00c< .001
≥ 28 years 1.39 (1.21–1.60) 1.48 (1.27–1.71)
Evaluators
Gender
Male 1.00c< .001 1.00c.012
Female 0.64 (0.51–0.81) 0.72 (0.55–0.93)
Age group
25–30 years 1.00c.034 1.00c.028
31–40 years 0.78 (0.57–1.06) 0.76 (0.56–1.04)
41–50 years 0.77 (0.54–1.09) 0.72 (0.50–1.03)
≥ 51 years 0.59 (0.41–0.85) 0.57 (0.39–0.84)
Training levele
Attending 1.00c< .001 —
Resident (PGY 1) 1.90 (1.40–2.59) —
Resident (PGY 2) 1.68 (1.21–2.35) —
Resident (PGY 3–5) 1.29 (0.95–1.76) —
Abbreviations: PGY indicates postgraduate year; OR, odds ratio; AOR, adjusted odds ratio.
aThe authors carried out a retrospective analysis of 4,272 third-year clerkship clinical performance evaluations
by 829 evaluators of 155 students to determine whether student and evaluator gender are associated with
assessment of overall clinical performance.
bA total of 32.9% of the variability in the grades was accounted for by “within-evaluator” nesting of grades in
the multivariable model (intraclass correlation coefficient = 0.33; P < .001).
cReference.
dBecause of the small number of evaluations, family medicine and psychiatry were combined for the multivariable
modeling.
eTraining level was not retained in the multivariable model because of high phi coefficient (0.84) between faculty
age quartile and training levels.

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Research Report
Academic Medicine, Vol. 92, No. 6 / June 2017 839
students’ clinical performance is most
perplexing. Medical students’ clinical
performance is influenced by attributes
outside of medical knowledge and
clinical acumen. Indeed, two studies22,23
reported that medical students who
showed empathy received better clinical
evaluations, and women scored higher
on empathy scales than men did.
Additionally, some studies22,23 found
that female students’ interpersonal skills
surpassed those of men. In primary care,
a study24 showed that female physicians’
communication skills surpassed those
of their male counterparts, which, if
future studies confirm this result, is
an important finding because doctor–
patient communication has been linked
to improved health outcomes.25 If the
body of literature showing that women
outperform men in the clinical setting is
applied, our findings suggest that female
evaluators accurately detected superior
performance in their female students,
while male evaluators either were unable
to detect these differences or were biased
in their grading methods.
However, it is likely that this finding
highlights an even more complicated
interplay between gender and academic
performance and assessment. As in
the primary education world, female
students’ “learning attitude” may also
play a role, as well as the possible role
modeling of same-gender evaluators and
the stereotype threat of opposite-gender
graders, which may influence students
to perform differently depending on
the gender of their evaluators. Another
potential complicating matter is that
patients may interact differently with
medical students depending on the
student’s gender, which could also affect
the assessment of their performance.
This has been demonstrated in a study26
examining physician–patient interaction,
where patients were found to speak
differently and make more psychosocial
disclosures to female physicians.
Whatever the cause, it is concerning that
our study findings suggest that male
and female students experience different
gradings of their clinical performances,
and that the gender of the evaluator is an
independent driver of this difference.
Our data also found a significant
interaction between evaluator age and
gender, with younger male evaluators
awarding higher grades than older male
evaluators and than female evaluators in
all age groups. While younger evaluators
have been found to be more lenient
graders in other studies,27,28 to our
knowledge the age–gender interaction
has not been examined elsewhere,
and this finding warrants additional
investigation. Again, it is concerning that
intrinsic evaluator characteristics have
led to differential grading of students.
Either improved training of graders
is needed, or the characteristics of the
evaluators must be taken into account
when considering their ability to give
fair clerkship grades.
Our data also demonstrate substantial
differences in the way clerkship students
are graded by department at our school,
a finding that we suspect applies to
many schools. This variability should
be examined to provide a consistent
approach to CPEs. Differences in the
structure and duration of the different
core clerkships, as well as the time
students spend with evaluators, must be
taken into consideration when looking
at CPEs. In some cases, the structure of
the clerkship and number of evaluators
providing CPEs may result in fewer
Figure 1 Two-way interaction effect of student and evaluator gender on predicted probabilities
of evaluators’ grading of male and female students on 4,272 clinical performance evaluations of
medical students completing third-year core clerkships at Alpert Medical School, 2013 to 2014.
Male evaluators did not significantly differ in their grading of male and female students (P = .29);
however, female evaluators gave lower grades to male students than to female students
(P < .001).
Figure 2 Two-way interaction effect of evaluator gender and age quartile on predicted probabilities
of their grading of male and female students on 4,272 clinical performance evaluations of medical
students completing third-year core clerkships at Alpert Medical School, 2013 to 2014. A significant
interaction between faculty age and faculty gender was found (P = .047), with older male evaluators
giving significantly lower grades than younger men (P = .001), while there was no significant
difference in grading for the female age groups (P = .71).

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Research Report
Academic Medicine, Vol. 92, No. 6 / June 2017
840
grading events per student, which may
exaggerate the influence of gender and
age on a student’s final clerkship grade.
Our study has some limitations. We
evaluated only one year of grading events
at one medical school in the United States.
A multicenter study would be needed
to see if these data are generalizable to
other institutions. The grading system
used is an ordinal one, and these data
may not be reflective of data produced by
other grading systems at other medical
schools. We were not able to adjust for
or compare clinical performance grades
with standardized test scores, since the
individual-level data were not available
in our dataset. Further, we recognize
that gender representation, and thus
gender interactions at a medical school in
2013–2014, might be very different from
what was obtained in previous years, when
gender relationships and generational
differences would perhaps skew data in
other ways.
Further study is needed to learn whether
the trends of gender-pairing influence on
grading at our medical school are found
at other medical schools. Additionally,
the cause of the grading differences by
evaluator and student gender is still
unknown. Next steps may include a
qualitative approach to discover reasons
for the discrepancy in how medical
students’ performance is perceived
and assessed by evaluators of different
genders.
Acknowledgments: The authors would like to
acknowledge the assistance of Alpert Medical
Schools’ Medical School Administrative Office
for the compilation of the dataset used for this
study. They would also like to thank Jennifer F.
Friedman, MD, MPH, PhD, for her mentorship
and guidance, and Kelvin Moore for his efforts
assisting with the literature review.
Funding/Support: None reported.
Other disclosures: None reported.
Ethical approval: This study was reviewed by the
Lifespan institutional review board and deemed
exempt. (Lifespan Corporation, Rhode Island’s
largest health system, is affiliated with the Alpert
Medical School of Brown University.)
Previous presentations: Pediatric Hospital
Medicine Conference, Chicago, Illinois, July 29,
2016; and Lifespan Annual Research Celebration,
Providence, Rhode Island, October 20, 2016.
A. Riese is assistant professor, Department of
Pediatrics and Medical Science, Section of Medical
Education, Alpert Medical School of Brown
University, Providence, Rhode Island.
L. Rappaport is a first-year pediatrics resident,
University of Michigan Medical School, Ann Arbor,
Michigan.
B. Alverson is associate professor, Department
of Pediatrics and Medical Science, Section of
Medical Education, Alpert Medical School of Brown
University, Providence, Rhode Island.
S. Park is postdoctoral research associate, Alpert
Medical School of Brown University and Center
for International Health Research at Rhode Island
Hospital, Providence, Rhode Island.
R.M. Rockney is professor, Department of
Pediatrics, Family Medicine, and Medical Science,
Section of Medical Education, Alpert Medical School
of Brown University, Providence, Rhode Island.
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