Faculty Aims to Better Detect Gender Imbalances in Learner Assessments

Nov 29, 2019
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The Faculty of Medicine, in collaboration with its affiliated teaching sites, is reviewing its processes to determine how to better detect – and flag for review – potential gender inequities and imbalances at clinical rotation sites for more than 3,600 medical trainees.

This commitment follows recommendations from an external committee that reviewed the learning environment for medical trainees in two hospital Emergency Department training sites beginning in the summer of 2019. The committee’s confidential report was delivered to Dean Trevor Young in late October. An executive summary is available here.

Flagging potential gender imbalances starts with data.

“We’ve never asked about the gender of our learners in teacher evaluations and rotation evaluations,” said Prof. Sal Spadafora, Vice Dean PostMD Education, whose office oversees postgraduate medical training programs across specialties, including Emergency Medicine.

“By flagging potential imbalances at clinical training sites we’re giving our learners – and our teaching faculty – the ability to strive for greater equity. If you don’t measure it, you can’t manage it.”

These system-wide improvements build on data-gathering and analysis led by the Faculty’s Office of Inclusion and Diversity (OID). Under the leadership of Associate Dean Lisa Robinson, the OID also advises and collaborates on the implementation of equity and diversity priorities for the Faculty in the areas of admissions, recruitment, curriculum education and faculty retention.

Last year, the Faculty received a letter from a lawyer representing a group of women physicians alleging gender discrimination in the Emergency Departments at Southlake Regional Health Centre, and in the past at St. Joseph’s Health Centre (SJHC). Many of the assertions related to matters of hospital jurisdiction, including hiring practices, Emergency Department scheduling and workplace professionalism.

The University encouraged the anonymous complainants to come forward so that it could review any issues that are squarely within its jurisdiction; that is, those specifically relating to Faculty of Medicine trainees and the clinical learning environment.

The Canadian Women in Medicine, and signatories to an online petition, urged the University to do more. An external committee was struck and it began its work in May 2019. This included a survey of 469 Southlake and St. Joseph’s residents who had completed an Emergency Department rotation between 2013-14 and 2017-18; the survey response rate was 22 per cent.

Through the summer the committee conducted 21 semi-structured 30-minute interviews (and two 60-minute interviews) with faculty, previous learners, emergency physicians and other health professionals from both hospitals. It also held two private, one-hour focus groups with current Family Medicine residents on separate days at St. Joseph’s and Southlake. And it reviewed all trainee evaluation data for the sites over a seven-year period. Its final in-person meeting was in August, with report-writing completed in September and October.

The report notes that the most consistent feedback from learners in rotation evaluations was lack of orientation, teaching was preceptor-dependent, and scheduling was disorganized.

The committee also offered a series of recommendations related to the Emergency Department learning environment including calling on the University to offer:

  • Greater faculty development on the learner/teacher assessment process in Emergency Departments;
  • More coordinated systems for trainee scheduling in Emergency rotations;
  • More consistent orientation sessions for learners prior to their first Emergency Department shift and;
  • Trainee mentorship opportunities with women physicians in Emergency Medicine.
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