Impact of Pregnancy and Gender on Internal Medicine Resident Evaluations: A Retrospective Cohort Study

Background: Pregnancy and its impact on graduate medical training are not well understood. Objective: To examine the effect of gender and pregnancy for Internal Medicine (IM) residents on evaluations by peers and faculty. Design: This was a retrospective cohort study. Subjects: All IM residents in training from July 1, 2004–June 30, 2014, were included. Female residents who experienced pregnancy and male residents whose partners experienced pregnancy during training were identified using an existing administrative database. Main Measures: Mean evaluation scores by faculty and peers were compared relative to pregnancy (before, during, and after), accounting for the gender of both the evaluator and resident in addition to other available demographic covariates. Potential associations were assessed using mixed linear models. Key Results: Of 566 residents, 117 (20.7%) experienced pregnancy during IM residency training. Pregnancy was more common in partners of male residents (24.7%) than female residents (13.2%) (p = 0.002). In the post-partum period, female residents had lower peer evaluation scores on average than their male counterparts (p = 0.0099). Conclusions: A large number of residents experience pregnancy during residency. Mean peer evaluation scores were lower after pregnancy for female residents. Further study is needed to fully understand the mechanisms behind these findings, develop ways to optimize training throughout pregnancy, and explore any unconscious biases that may exist.