Abstract
BACKGROUND: Accurate self-assessment is critical for self-directed learning and clinical competency development. Identifying factors that influence resident's competency-based assessments is imperative to address potential disparities and foster an equitable training environment. However, studies on the relationship between demographic characteristics, such as gender and race, and self-assessment are scarce. This study aims to examine the alignment between residents' self-assessment and faculty evaluation of clinical competencies and investigate the gender- or race-related discrepancies in assessment. METHODS: This retrospective study analyzed Accreditation Council for Graduate Medical Education milestone scores and self-assessments from clinical anesthesiology residents at a single site over 6 academic years (December 2015 through June 2021). Semiannual Clinical Competency Committee (CCC) assessments and resident self-assessments were compared to measure assessment alignment. Data were analyzed using mixed-effects analysis of variance and Tukey test. RESULTS: The sample included 17 773 subcompetency ratings from 117 residents with no significant gender or race effects on CCC scores. Self-assessment scores showed a significant gender-race interaction in professionalism milestones (p = .025) with female white residents rating themselves lower than their female nonwhite (mean [95% confidence interval or CI] =14.26 [13.23, 15.30] versus 16.37 [15.15, 17.61], p = .049) and male white peers (mean [95% CI] = 14.26 [13.23, 15.30] versus 16.15 [15.41, 16.89], p = .020). Residents generally overestimated their competencies compared to CCC scores (p range: < .0001 to .702) with notable improvement in assessment alignment over time (p range: < .0001 to .002) except for interpersonal and communication skills (p = .091). White residents' medical knowledge assessment alignment was better than the nonwhite residents (mean difference, 95% CI = .22 [.03, .40], p = .027). CONCLUSIONS: Our study investigated the underexplored area of the roles gender and race play in residents' competency assessments. The findings suggest that further research is warranted to explore the impact of personal characteristics on competency assessment and to develop targeted interventions for improving competency assessment and reducing potential biases.