What's in a Word? Qualitative and Quantitative Analysis of Leadership Language in Anesthesiology Resident Feedback

Background Individuals who have agentic traits (eg, assertive, confident, competent) that are more commonly associated with men are often selected for leadership roles. For women, this poses a potential barrier to entry into the higher ranks of academic medicine. Objective We analyzed anesthesiology resident feedback for differences in the use of agentic descriptors using qualitative and quantitative methods based on resident gender and year of training. Methods This study uses textual analysis of 435 assessments of residents over a 1-year period within a single residency program. We performed a qualitative content analysis on the words used in resident feedback and performed negative binomial regression analyses to determine significant differences in the way residents were described based on gender and year of training. Results Female residents were less likely than male residents to be described as agentic after controlling for excerpt length, year of training, and evaluator variability (β = –0.347; 95% confidence interval [CI] –0.666, –0.028; P = .033). Senior residents were more likely to be described as agentic (β = 0.702; 95% CI 0.402–1.002; P < .001) compared to junior residents. The increased number of agentic codes among senior residents was driven by increased agentic description of female residents' ratings in the senior cohort (β = 0.704; 95% CI 0.084–1.324; P = .026). Conclusions Female residents were described as agentic less often than male residents in early years of training, but the gap was not present among senior residents.