Assessment of Pediatric Residents in the United States by Sex, Ethnoracial and Intersectional Group

Introduction: Inequitable assessments in medical education disproportionately affect historically marginalized trainees and undermine development of a diverse physician workforce. With programs around the world incorporating competency-based medical education (CBME), understanding whether assessment disparities exist in specialty-specific competency frameworks is critical. This study examined disparities in program-reported performance assessments of pediatric residents across demographic groups in two pediatric-specific competency frameworks: the General Pediatrics Entrustable Professional Activities (EPAs) and Accreditation Council for Graduate Medical Education (ACGME) pediatric milestones.

Methods: This prospective cohort study was conducted at 15 pediatric residency programs in the U.S. across the 2021–22, 2022–23, and 2023–24 academic years. Clinical Competency Committee-assigned entrustment-supervision levels for 5 EPAs and all milestone levels were collected twice yearly. Residents self-reported ethnoracial group and sex, analyzed as exposure to systems of racism and sexism. Time-to-event analysis and growth curve modeling with intersectional analytic approaches examined disparities across demographic groups.

Results: 475 of 803 (59%) residents completed demographic surveys, including 17.3% underrepresented in medicine (URiM), 22.9% Asian, 56.4% white, 70.7% female, and 27.8% male. Time-to-event analyses revealed significant differences for Asian and Asian female residents in reaching the highest EPA supervision level across all EPAs. Growth curve analyses showed Asian males had significantly flatter growth trajectories for EPA 15 (Lead an Interprofessional Team), resulting in lower estimated scores at graduation. URiM female residents had significantly lower scores on EPA 16 (Facilitate Handovers) at graduation. URiM residents showed lower Milestone growth curves for interpersonal communication, and Asian residents for systems-based practice.

Discussion: Subtle but meaningful disparities exist in program-reported assessments of pediatric residents, with distinct patterns affecting Asian and URiM residents across both frameworks. These findings highlight the need for proactive attention to equity in competency-based medical education assessment systems.