Dressing the Part: Gender Differences in Residents' Experiences of Feedback in Internal Medicine.

Purpose: Multiple studies demonstrate that assessment of residents differs by gender, yet little is known about how these differences are experienced by women and men. The authors sought to understand whether the experience of being assessed and receiving feedback differs between men and women internal medicine (IM) residents and how women respond to these experiences.

Method: A constructivist grounded theory approach to data collection and interpretation was used. The authors invited all IM residents in postgraduate years 1-3 at the University of Toronto to participate in semistructured focus groups (August-October 2019). Twenty-two residents participated (8 men, 14 women). Focus groups were divided by gender and training level.

Results: The authors found a profound difference in experiences of receiving feedback between men and women residents. The themes of challenges to power and authority, tactics to reestablish power and authority, conflicting feedback from attendings, and ways of moving forward all diverged between men and women residents. Women repeatedly brought up feedback outside of official assessment moments and relied on symbols, such as a white coat, stethoscope, and demure clothing, to "dress the part" of a physician. Women also encountered conflicting feedback from supervisors regarding confidence and assertiveness (e.g., sometimes told to be more assertive, other times to be less), often resulting in self-censorship; similar feedback was rarely noted by men.

Conclusions: Gendered differences in the experiences of being assessed and receiving feedback are not always reflected in standard measures. Gender and medicine can be considered performative, and these findings demonstrate women IM residents integrate multiple forms of feedback to create the persona of the woman physician. The authors believe this research contributes a unique vantage point to the experience of women residents interpreting explicit and implicit feedback in IM and highlights the socialization that occurs to become a woman physician.