Gender Differences in ACGME Milestones 1.0 Ratings (2014–2022)

Background: Plastic and reconstructive surgery has improved its equitable representation of men and women in residency training. However, previous studies in plastic surgery education and other surgical specialties have shown differences in how men and women residents are rated. With the implementation of time-variable training, potential systemic biases in resident assessment could result in substantial, cumulative, negative outcomes for individual residents’ training trajectories. We performed the current study using the Accreditation Council for Graduate Medical Education (ACGME) Plastic Surgery Milestones 1.0 data to identify any assessment differences between men and women resident physicians from 2014-2022. Methods: After securing local IRB-approval, we obtained de-identified ACGME Milestones 1.0 data from the ACGME for July 2014-June 2022. We used integrated residents’ semi-annual scores to look at each Milestone individually by post-graduate year (PGY), stratifying by gender, (i.e. man, woman). We used simple statistics (mean, standard deviation) to identify average scores for men and women for each of the 36 Milestones. Results: Of the n=1,887 unique integrated residents for whom 452,520 Milestones assessments were completed, n=1,245 had self-provided gender data and were included in the analysis. For all 36 PRS 1.0 Milestones, women residents had a lower average rating than their men peers until PGY-3 (n=1 Milestone), PGY-4 (n=14 Milestones), or PGY-5 (n=19 Milestones), after which point men’s and women’s average scores for most Milestones overlapped. Women resident ratings continued to be lower than their men peers through PGY-6 for four Milestones: Upper Extremity Trauma–Medical Knowledge, Upper Extremity Trauma–Patient Care, Non-Trauma Hand–Medical Knowledge, and Non-Trauma Hand–Patient Care. Conclusion: This national study of the ACGME Milestones 1.0 data found that women residents were rated lower on average that their men peers across all 36 Milestones, most commonly through PGY-3 or PGY-4; therafter, women’s ratings demonstrated increased overlap with men’s ratings. Given the implementation of time-variable training in plastic and reconstructive surgery, and considerations for how to include artificial intelligence in the resident assessment process, it is important to understand what may cause these scoring differences and what, if any, action should be taken to address it. Additional studies are needed to further elucidate these findings.