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 dis-parities 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 resi-dency, 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% confi-dence interval, 1.02-1.38). When examining the intersection of race -eth-nicity 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 inter-val, 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 sig-nificantly by race-ethnicity, sex, and the intersection of these factors.