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Avoiding Gender Bias Using a Gender Neutral Scoring System: The Case Western Plastic Surgery Resident Application Assessment
Katherine Grunzweig, MD1, Sven Gunther, MD1, Lisa DiNardo, PhD1, Edward Davidson, MD1, Ali Totonchi, MD2, Anand Kumar, MD1.
1University Hospitals Cleveland Medical Center, Cleveland, OH, USA, 2MetroHealth System, Cleveland, OH, USA.

Background: The effects of subjective gender bias during the plastic surgery residency application process remains understudied. We hypothesized that an objective merit-based gender-neutral algorithm results in a gender distribution of interviewees proportional to the applicant pool. This study evaluated the efficacy of the Case Western Resident Application Assessment (CWRAA) as a tool to screen applicants while avoiding gender bias. This tool has been in effect for the past five years.
Methods: A retrospective study was conducted using the CWRAA, a tool utilizing a tripartite weighted system evaluating USMLE Step 1 scores, publications/posters/presentations, and academic achievements including AOA and school ranking. Each category assigns points, adding to 15. Five years of applicant data was assessed for gender, interview invites, ranking, rank position, and matching with our institution. Welch two sample t-tests were used to assess average scores, and the chi-squared test was used to assess gender proportions. Effect size was assessed using means and pooled standard deviations.
Results: Over 5 years, 829 applicants, 61.9% male, 38.1% female applied to the residency program. Average CWRAA score for all applicants was 6.68, median 7. There was no significant difference in mean scores between genders (p=0.62). The average scores of those offered interviews were not significantly different: male average was 6.8 (SD 2.83), female average 6.48 (SD 3.02), and p=0.13 [CI -0.1 to 0.7]. The proportion of genders granted interviews was not different (18.1% of male applicants invited, 16.8% of female applicants invited; p=0.69). Of applicants present on interviews, there was no difference in scores and proportions between genders (male 6.66, female 6.72; p=0.77 [CI -0.5 to 0.4]; p=0.87). Ranked applicants had no difference in score or gender proportion (male 6.76, female 6.55; p=0.3 [CI -0.2 to 0.6]; p=0.94). The proportion of female residents who matched out of the female resident pool, compared to males, was found to be significant (p=0.049). Scores were not significantly different (males 6.73, females 6.66, p=0.76 [CI -0.3 to 0.5]).
Conclusions: Our study demonstrated that the CWRAA score system is an objective ranking mechanism of applicants based on multiple non gender specific metrics, accounting for differences in opportunity for research, test-taking, and academic awards. Subjective assessment does not ultimately come into play until residents are interviewed at the institution. Using an objective metric to filter applicants does not result in unequal gender proportions, suggesting an objective merit-based algorithm helps avoid gender bias in the application process.


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