Racial and sex disparities in the selection of chief residents in obstetrics and gynecology

Background: Racial and ethnically minoritized individuals and women are underrepresented in leadership roles in academic medicine. Little is known about whether and to what extent these racial and sex disparities exist in graduate medical education.

Objective: This study aimed to determine whether race-ethnicity or the intersection of race-ethnicity and sex impact the likelihood of being selected as chief resident in obstetrics and gynecology residency programs.

Study design: We performed cross-sectional analyses using data from Graduate Medical Education Track, a national resident database and tracking system. Those included in this analysis were final-year obstetrics and gynecology residents in US-based residency programs from 2015 to 2018. The exposure variables were self-reported race-ethnicity and sex. The outcome was being selected as chief resident. A logistic regression was used to estimate the odds of being selected as chief resident. We tested the following variables for potential confounding: survey year, United States citizenship, medical school type, geographic region of residency, and Alpha Omega Alpha status.

Results: There were 5128 residents included. Black residents were 21% less likely to be selected as chief resident than White residents (odds ratio, 0.79; 95% confidence interval, 0.65-0.96). Females were 19% more likely to be chief resident than males (odds ratio, 1.19; 95% confidence interval, 1.02-1.38). When examining the intersection of race-ethnicity and sex, the results revealed some heterogeneity. Among males, Black individuals had the lowest odds of being selected as chief resident (odds ratio, 0.32; 95% confidence interval, 0.17-0.63; referent White males), whereas among females, Hispanic individuals were the least likely to be selected as chief resident (odds ratio, 0.69; 95% confidence interval, 0.52-0.92; referent White females). White females were almost 4 times more likely to be selected as chief resident than Black males (odds ratio, 3.79; 95% confidence interval, 1.97-7.29).

Conclusion: The odds of being selected as chief resident differ significantly by race-ethnicity, sex, and the intersection of these factors.