2620 - Resident Perceptions of Bias in Competency Assessment in U.S. Radiation Oncology Programs

Purpose/Objective(s): Radiation oncology (RO) residency programs attempt to objectively evaluate competency based on 6 pre-specified milestones. We assessed resident perception of equitable competency assessment and evaluation outcomes.

Materials/Methods: An anonymous survey was distributed to US RO residents via listservs, social media, and organizational outreach (Society for Women in RO and the Association of Residents in RO). Self IDentity (sID; defined as “race/ethnicity, gender identity, or caregiver status”) data was collected. Two survey sections were: 1) whether 6 milestones could be evaluated equitably, 2) whether sID influences 4 resident evaluation outcomes. The 6 resident milestones were: patient care; medical knowledge; systems-based practice; practice-based learning/improvement; professionalism; and interpersonal/communication skills. The 4 evaluation outcomes were: competency assessment; perception by faculty; disciplinary action; and job prospects. Participants rated responses on 5-point Likert scale (Strongly disagree to Strongly Agree); agreement constituted “strongly agree” or “agree.” Frequencies/percentages were compared by sID (Fisher’s exact test).

Results: Forty-one respondents completed the survey including 17 (45%) non-Hispanic White (NHW), 8 (21%) Asian, and 13 (34%) Other Race (inclusive of Hispanic/Latinx, Black/African American, Middle Eastern/North African, American Indian/Alaska Native/Native Hawaiian Pacific Islander), and 3 missing. Most identified as cis- or transwomen (81%; 19% cisgender men, 4 missing). Sixteen (41%) reported having children and 7 (18%) reported other caregiving (2 missing). Fewer than half agreed that all 6 milestones could be evaluated equitably (n=17/40, 42%, 1 missing); professionalism (49%) and interpersonal/communication skills (53%) had the lowest agreement. NHW residents were more likely to agree that all milestones could be evaluated equitably (71%, p=.005), compared to Asian (12.5%) or Other Race (23%). Most (n=21/40, 53%, 1 missing) agreed that sID influenced at least one evaluation outcome. By sID, race/ethnicity was the most reported factor (39%), followed by caregiver status (27%) and gender identity (24%). sID was most often reported to affect perception by faculty (43%) and disciplinary action (40%). Men were less likely to agree that sID influences evaluation outcomes in their residency program (20%) vs women (63%, p=.044). NHW respondents were less likely to report sID influences evaluation outcomes (35%, p=.043), vs Asian (88%) or Other (62%).

Conclusion: Most RO residents surveyed did not agree that competency milestones could be evaluated equitably, especially professionalism and interpersonal/communication skills. Residents surveyed agreed race/ethnicity, gender identity, and caregiver status influence evaluation outcomes, particularly disciplinary action and perception by faculty. Increased objectivity and transparency in resident assessment may be warranted.