Proportion of female recipients of resident-selected awards across Canada from 2000 to 2018: a retrospective observational study
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* Sarah Silverberg
* Shannon M. Ruzycki

## Abstract

**Background:** Female physicians have been shown to receive fewer awards from medical societies than their male colleagues. We examined the sex distribution of recipients of Canadian residency association awards.

**Methods:** We conducted a retrospective observational study of the sex of staff and resident physician recipients of resident-selected awards from provincial and national residency associations using data from 2000–2018. We classified awards into professionalism, advocacy and wellness awards, and education and teaching awards based on award names and descriptions, and compared the proportion of male and female recipients in these categories.

**Results:** We identified 314 recipients of staff physician awards and 129 recipients of resident physician awards. Male staff and resident physicians had higher odds of receiving awards than their female counterparts (odds ratio [OR] 1.45, 95% confidence interval [CI] 1.13–1.89 and OR 1.70, 95% CI 1.18–2.46, respectively). There was a reduction in the odds of male residents’ receiving an award over the study period (OR 0.94, 95% CI 0.90–0.98). Male physicians had higher odds of receiving education and teaching awards than female physicians as staff but not as residents (OR 3.21, 95% CI 1.72–5.95 and OR 1.96, 95% CI 0.84–4.60, respectively).

**Interpretation:** Male staff and resident physicians in Canada had higher odds of receiving awards from provincial and national residency associations between 2000 and 2018 than their female counterparts. Given this disparity, it would be prudent for organizations that distribute awards to physicians, residents and medical students to examine their nomination criteria and processes for potential bias.

In Canada, the number of women admitted to medical schools has exceeded the number of men for 25 years.1 Despite over 2 decades of numerical parity, evidence shows that female physicians continue to be underrepresented in academia, leadership and administration in Canada and worldwide.2–9 Substantial evidence exists that female physicians are held to a higher standard than their male peers in evaluations, assessments, grant applications, publishing and reference letters.10–19 Although there is evidence for explicit bias against female physicians,20–22 most bias is implicit, manifesting in subtle ways such as word choice when describing trainees and differential access to operating time.11,23–28

Awards from residency associations allow residents to recognize physicians for their contributions. Unlike awards issued by other organizations, awards from residency associations reflect the values of residents, who may have different levels of bias than practising physicians. These awards may contribute to promotion, hiring, prestige and recognition.29,30

Previous studies that have examined award recipients by sex have focused on awards given to staff physicians by national societies.29,31–34 We sought to evaluate whether male staff and resident physicians are more likely to receive an award from Canadian residency associations than female physicians.

## Methods

We conducted a retrospective observational study of award recipient sex for staff and resident physicians who received awards from Canadian residency associations for 2000–2018.

### Setting

In Canada, there are 17 medical faculties distributed across 10 provinces: 6 in Ontario, 4 in Quebec, 2 in Alberta, and 1 each in Newfoundland and Labrador, the Maritime provinces, Manitoba, Saskatchewan and British Columbia. There are 8 provincial or regional residency associations that represent residents in these 17 medical schools to local governments and health organizations. In addition, there is a single national organization that coordinates representation of residents across Canada. These associations represent over 10 000 resident doctors.35

### Data sources

We identified recipients of staff and resident awards by contacting Canadian residency associations through their websites’ main contact email (Appendix 1, available at [www.cmajopen.ca/content/8/2/E242/suppl/DC1](http://www.cmajopen.ca/content/8/2/E242/suppl/DC1)). We contacted each organization at least twice to request records of awards given to staff and residents physicians from 2000 to 2018. We verified the names of award recipients using publicly available sources, including association and university websites and the association’s official social media (Twitter and Facebook), when available. We collected the name, faculty status and discipline of the recipient, as well as the year and description of each award. Data were considered missing if the residency association confirmed that an award had been distributed but was unable to provide the name or sex of the recipient(s). Missing data were omitted, and we assumed that the sex of recipients was missing completely at random. Nonphysician award winners were excluded from analysis.

Recipient sex was assigned independently by the 2 authors based on the association’s webpage or the directory of the provincial college of physicians and surgeons. Other publicly available records, including obituaries, were used if necessary to determine sex. We determined interrater agreement using the Cohen κ statistic. The recipient’s discipline of practice was assigned based on his or her current registration with the relevant college of physicians and surgeons. We categorized discipline into 4 main categories — family medicine, laboratory medicine specialties, medical specialties and surgical specialties — based on the classification of the Canadian Post-M.D. Education Registry, a central source for all postgraduate medical education data.36 Disagreements were reconciled by discussion between the 2 authors and comparison of the data source; further disagreements were resolved by a third, independent researcher. Recipients who received multiple awards were included for each award received.

#### Staff physicians

We determined the total number of male and female staff physicians eligible to receive awards per year by 2 methods. First, we defined faculty physicians using publicly available data from the Association of Faculties of Medicine of Canada,1 which provides the number of full-time physician members at each faculty of medicine. This number represents physicians in academic faculties who are most likely to interact with residents and therefore receive awards from residents. The database, however, does not capture all physicians with whom residents interact, especially those who work in the community nonacademic hospitals through which residents rotate.

Data on sex of physician faculty members were available in the Association of Faculties of Medicine of Canada database for 2011–2017. We extrapolated the number of female and male faculty members in Canada for 2000–2011 and 2018 based on the mean change in numbers of male and female faculty physicians per year for 2011–2017.

We also estimated the number of male and female practising physicians eligible to receive awards from a list of all physicians (nontrainee) who work in Canada obtained from the Canadian Medical Association (CMA).37 These data were available by request for 2005–2018. We extrapolated data for 2000–2004 based on the mean change in male and female physicians from 2005 to 2018, as described above. We also used CMA data to determine the number of female and male physicians practising in each discipline category.

#### Residents

We determined the total number of eligible male and female residents per year using data from the Canadian Post-M.D. Education Registry.36 The registry has collected data on the number of resident physicians annually since 1986 from the Canadian faculties of medicine; these data are cross-referenced for errors. Residents attending universities in provinces with missing award recipient data were excluded from analyses. For example, data on award recipient sex for 2003 were available only from the Ontario residents association; therefore, we included only male and female residents registered at Ontario universities as eligible to receive awards for that year. Specific awards from the Professional Association of Residents of Ontario, such as the Resident Teaching Award, were awarded only to specific universities during the study period; for example, the Professional Association of Residents of Ontario awards a Resident Teaching Award to each university individually. Only residents attending universities that distributed an award were included as eligible.

### Award category

Each award was classified independently by the 2 authors as 1) education and teaching or 2) professionalism, advocacy and wellness (resident or patient) based on the award name or description. We chose these 2 categories to distinguish the medical expert role from other CanMEDS roles as there is evidence that medical expert awards may contribute more to promotion decisions than other awards.38 CanMEDS is a framework for Canadian residency education that describes the key competencies of physicians: scholar, professional, communicator, collaborator, health advocate and leader, all of which overlap with the central role of medical expert.39 We considered 38 award categories (Appendix 2, available at [www.cmajopen.ca/content/8/2/E242/suppl/DC1](http://www.cmajopen.ca/content/8/2/E242/suppl/DC1)). For analyses based on award category subgroups, we excluded awards that did not clearly indicate its category subgroup (e.g, “merit” or “spirit” awards). Disagreements were reconciled by discussion between the 2 authors and comparison of the data source; further disagreements were resolved by a third, independent researcher. We determined interrater agreement using the Cohen κ statistic.

### Statistical analysis

We calculated the median and interquartile range (IQR) for the proportion of female award recipients per year. We performed frequentist analysis by defining odds ratios (ORs) as the odds of male staff or resident physicians’ receiving awards compared to the odds of female staff or resident physicians’ receiving awards. For staff physicians, we calculated ORs using the number of male and female faculty physicians (Association of Faculties of Medicine of Canada data) and also using the total number of male and female practising physicians (CMA data). We calculated these ORs, 95% confidence intervals (CIs) and 2-sided Fisher exact *p* values. We performed logistic regression to evaluate the association of recipient sex and odds of receiving an award, adjusted for year.

In addition, we constructed Bayesian binomial models for staff and resident physicians, with sex as the single covariate. We estimated the effect of sex within each specialty category using a hierarchical random effects model. Bayesian regression requires specification of distributions representing the possible range of effect for each parameter before the data are incorporated. We defined prior distributions for each of the parameters as follows: intercept (0,3), coefficient normal (0,2), standard deviation Cauchy (0,1) and correlation between intercept and slope as LKJ (3). For this study, the median of the posterior distribution was reported as the primary measure of association with 95% posterior intervals (PIs), which do not describe statistical significance but, rather, the uncertainty range compatible with 95% of subjects.

We performed all analyses using Stata release 15 (StataCorp.).

### Ethics approval

We received a waiver of ethics approval from our institutional ethics board because we used publicly available data for this study.

## Results

All 9 associations responded to the data request. One association did not issue any awards, and another did not distribute awards to residents during the study period. The remaining 7 associations provided data for staff and resident physicians (Table 1; Appendix 2). When we verified the data provided by 5 associations using publicly available sources, we noted no discrepancies. Agreement between reviewers who assigned recipient sex based on names was high (Cohen κ = 0.95). We were able to assign sex using the relevant provincial college of physicians and surgeons data for all but 3 award applicants, whose sex was identified by pronoun use in an obituary.

View this table:
[Table 1:](http://www.cmajopen.ca/content/8/2/E242/T1)

Table 1: 
Number of awards distributed to staff and resident physicians by Canadian provincial and national residency associations, 2000–2018, by award category*

### Staff physician award recipients

There were 314 staff physician award recipients in 2000–2018 (Table 1). Award recipient data were missing for 26 awards (7.6%). There were 5–29 awards distributed per year (Table 2). The median proportion of female staff physician recipients per year was 26.1% (IQR 17.9%–32.3%). In total, 84 (26.8%) recipients of staff physician awards were female.

View this table:
[Table 2:](http://www.cmajopen.ca/content/8/2/E242/T2)

Table 2: 
Number of full-time faculty physicians who received an award from a Canadian residency association proportion, by sex, and odds of receiving an award*

Overall, the odds of a male staff physician’s receiving an award was greater than that of a female physician (OR 1.45, 95% CI 1.13–1.89). This result did not change when we included all eligible practising physicians (CMA data) (OR 1.64, 95% CI 1.28–2.13) or with Bayesian modelling (OR 1.95, 95% PI 1.54–2.46) (Table 3). The odds of a male staff physician’s receiving an award increased over the study period (OR 1.03, 95% CI 1.01–1.05) (Figure 1). After adjustment for year, male sex continued to be associated with higher odds of receiving an award as a staff physician (OR 1.53, 95% CI 1.19–2.96).

View this table:
[Table 3:](http://www.cmajopen.ca/content/8/2/E242/T3)

Table 3: 
Recipients of awards stratified by recipient discipline

![Figure 1:](http://www.cmajopen.ca/https://www.cmajopen.ca/content/cmajo/8/2/E242/F1.medium.gif)

[Figure 1:](http://www.cmajopen.ca/content/8/2/E242/F1)

Figure 1: 
Proportion of eligible full-time faculty physicians in Canada who won residency association awards, 2000–2018, by sex (Association of Faculties of Medicine of Canada data).

### Resident physician award recipients

There were 129 resident physician awards distributed between 2002 and 2018, with 2–16 awards distributed per year (Table 1, Table 4). The sex of the award recipients was missing for 4 awards (3.1%). Fifty-two resident recipients (40.3%) were female. The median proportion of female award recipients per year was 40.0% (IQR 25.0%–42.9%).

View this table:
[Table 4:](http://www.cmajopen.ca/content/8/2/E242/T4)

Table 4: 
Number of resident physicians who received an award from a Canadian residency association, by sex, and odds of receiving an award*

Overall, frequentist and Bayesian modelling showed that the odds of male residents’ receiving an award was greater than that of female residents (OR 1.70, 95% CI 1.18–2.46 [Table 4] and OR 1.54, 95% PI 1.14–2.18 [Table 3], respectively). The odds of a male resident’s receiving an award decreased during the study period (OR 0.94, 95% CI 0.90–0.98) (Figure 2). Male residents had higher odds of receiving an award after adjustment for award year (OR 1.70, 95% CI 1.20–2.43).

![Figure 2:](http://www.cmajopen.ca/https://www.cmajopen.ca/content/cmajo/8/2/E242/F2.medium.gif)

[Figure 2:](http://www.cmajopen.ca/content/8/2/E242/F2)

Figure 2: 
Proportion of eligible resident physicians in Canada who won residency association awards, 2002–2018, by sex.

### Award categories

Of the 314 staff awards, 310 were classifiable (Table 5). Agreement between reviewers who assigned award category was excellent (Cohen κ = 1.00). Female staff physicians accounted for 30 (46.9%) of the 64 professionalism, advocacy and wellness award recipients and 53 (21.5%) of the 246 education and teaching award recipients. Male physicians were more likely to win an education and teaching award than female physicians (OR 3.21, 95% CI 1.72–5.95).

View this table:
[Table 5:](http://www.cmajopen.ca/content/8/2/E242/T5)

Table 5: 
Number of staff and resident physician recipients of professionalism, advocacy and wellness awards, and education and teaching awards

A total of 117 of the 129 resident awards were classifiable (Table 5). Female residents received 20 (50.0%) of the 40 professionalism, advocacy and wellness awards and 26 (33.8%) of the 77 education and teaching awards. Male residents did not have higher odds of receiving an education and teaching award after adjustment for award year (OR 1.96, 95% CI 0.84–4.60).

### Recipient discipline

Recipient discipline was available for 222 recipients of staff physician awards (70.7%) and 110 recipients of resident physician awards (85.3%). Bayesian modelling showed that male staff and resident physicians had higher odds of receiving awards than female staff and resident physicians in all specialty categories (Table 3). There was greater uncertainty in estimates for laboratory and family medicine, but the data were most compatible with greater odds of male physicians’ receiving awards in these specialties as well (Appendix 3, available at [www.cmajopen.ca/content/8/2/E242/suppl/DC1](http://www.cmajopen.ca/content/8/2/E242/suppl/DC1)).

## Interpretation

Our study shows that, from 2000 to 2018, male physicians had higher odds of receiving awards as staff and residents than did female physicians. There were no years in which there were more female recipients of staff physician awards than male recipients. The proportion of eligible female staff physicians who received awards was lower than the proportion of eligible male staff physicians who won awards for all but 3 years in the study period. Similarly, despite accounting for more than half of all residents since 2008, female residents received more awards than male residents in only 3 study years. Male staff and resident physicians from all specialty categories were more likely to win awards than their female counterparts. Altogether, these results suggest that female physicians were consistently underrepresented as award recipients relative to their overall proportion in Canada from 2000 to 2018.

In addition, female physicians were more likely than male physicians to receive professionalism, advocacy and wellness awards than education and teaching awards. Education and teaching awards are used for promotion decisions, whereas the value of receiving a wellness award is less established.38 This finding is consistent with literature showing that female physicians receive lower ratings on teaching evaluations than their male colleagues, even after teaching quality is controlled for.18 In deception-design studies, students rated teachers whom they perceived as women lower than those they perceived as men, even when the actual gender of the instructor varied.40

Our results are consistent with studies describing under-representation of female physicians as recipients of awards from medical and surgical specialty societies.31–33,41 Female medical students have also been shown to be less likely to receive an honours distinction on a research thesis than their male peers, even after adjustment for mentorship, advanced degrees and time spent on the project.42

Overall, our study on resident association awards adds to the current body of literature suggesting that female physicians are evaluated less favourably than male physicians in multiple settings, including teaching evaluations,18 student evaluations,11 prestigious research awards43 and grant applications. 19,44 Of note, these differences are not shown consistently. 45 We have identified bias against female physicians in the selection of residency association awards; this bias may further perpetuate inequities in hiring, promotion and grant attainment. Best practice guidelines on how to avoid wording in applications that discourage female applicants or nominations may be helpful.

### Limitations

This study is limited by the small number of awards presented per year, in particular for resident physicians, which limited the study’s power to detect differences for individual years. Not all residency organizations kept consistent records, and there are missing data. As well, there is no validity evidence for the accuracy or completeness of registry data used to estimate the number of eligible physicians, and the numbers of female and male physicians in residency and active practice and working as faculty members were estimated for some years. We were able to compare only the proportion of female and male physicians who received awards, not the proportion who were nominated. Therefore, we were not able to determine whether the discrepancy between the sexes occurred on the basis of award criteria or nominations or in recipient selection processes.

In addition, we had to make several assumptions when estimating how many staff physicians were eligible for awards. We assumed that all faculty physicians working at Canadian medical schools, regardless of sex, had equal probability of receiving an award; this does not account for differences in seniority, academic rank and other factors that may affect the likelihood of receiving an award that differ by physician sex. Furthermore, the number of male and female faculty and practising physicians in Canada had to be estimated for some years of analysis owing to missing data.

Our data sources did not allow nonbinary categorizations of gender. Our study did not include local awards, such as those given by individual schools and faculties of medicine. Finally, without access to the actual awards applications, we could not control for the effects of application quality, nor could we adjust for other measured or unmeasured confounders.

### Conclusion

Male staff and resident physicians in Canada had higher odds of receiving awards from provincial and national residency associations between 2000 and 2018 than their female counterparts. Given this disparity, it would be prudent for organizations that distribute awards to physicians, residents and medical students to closely examine their nomination criteria and processes for potential bias. We suggest that processes be developed within organizations to encourage an equitable nomination pool for awards.

## Acknowledgements

The authors thank Dr. Irene Ma for providing mentorship on the study design, assisting with the statistical modelling and acting as third reviewer in the case of disagreements, and Dr. Daniel J. Lane for assisting with the statistical modelling. Rita Alemao assisted with administrative tasks that contributed to this project.

## Footnotes

*   **Competing interests:** Sarah Silverberg is a member of the executive boards of Resident Doctors of Canada and Resident Doctors of British Columbia but is not involved in awards selection. No other competing interests were declared.

*   This article has been peer reviewed.

*   **Contributors:** Sarah Silverberg conceived the study. Shannon Ruzycki analyzed the data. Both authors contributed to the study design, obtained the data, interpreted the data, drafted the manuscript and revised it critically for important intellectual content, approved the final version to be published and agreed to be accountable for all aspects of the work.

*   **Funding:** The publication costs for this study were funded by the John A. Buchanan Chair of General Internal Medicine at the University of Calgary.

*   **Disclaimer:** The funding source had no role in the design or conduct of the study, its analyses, interpretation of the data or decision to submit the results.

*   **Supplemental information:** For reviewer comments and the original submission of this manuscript, please see [www.cmajopen.ca/content/8/2/E242/suppl/DC1](http://www.cmajopen.ca/content/8/2/E242/suppl/DC1).

## References

1.  (2018) Canadian medical education statistics (Association of Faculties of Medicine of Canada, Ottawa).
    
    

2.  CMA Board of Directors (2019) (Canadian Medical Association, Ottawa) Available: [https://www.cma.ca/cma-board-directors](https://www.cma.ca/cma-board-directors). accessed 2019 June 27.
    
    

3.  Alyono JC, Jackler RK, Chandrasekhar SS (2018) Women of the American Otological Society. Otol Neurotol (4S Suppl 1):S69–80.
    
    

4.  Bismark M, Morris J, Thomas L, et al. (2015) Reasons and remedies for under-representation of women in medical leadership roles: a qualitative study from Australia. BMJ Open 5:e009384.
    
    [Abstract/FREE Full Text](http://www.cmajopen.ca/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiQUJTVCI7czoxMToiam91cm5hbENvZGUiO3M6NzoiYm1qb3BlbiI7czo1OiJyZXNpZCI7czoxMjoiNS8xMS9lMDA5Mzg0IjtzOjQ6ImF0b20iO3M6MjA6Ii9jbWFqby84LzIvRTI0Mi5hdG9tIjt9czo4OiJmcmFnbWVudCI7czowOiIiO30=) 

5.  Silver JK, Ghalib R, Poorman JA, et al. (2019) Analysis of gender equity in leadership of physician-focused medical specialty societies, 2008–2017. JAMA Intern Med 179:433–5.
    
    

6.  Potvin DA, Burdfield-Steel E, Potvin JM, et al. (2018) Diversity begets diversity: a global perspective on gender equality in scientific society leadership. PLoS One 13:e0197280.
    
    [CrossRef](http://www.cmajopen.ca/lookup/external-ref?access_num=10.1371/journal.pone.0197280&link_type=DOI) 

7.  Tricco AC, Thomas SM, Antony J, et al. (2017) Strategies to prevent or reduce gender bias in peer review of research grants: a rapid scoping review. PLoS One 12:e0169718.
    
    [CrossRef](http://www.cmajopen.ca/lookup/external-ref?access_num=10.1371/journal.pone.0169718&link_type=DOI) 
    
    [PubMed](http://www.cmajopen.ca/lookup/external-ref?access_num=28061509&link_type=MED&atom=%2Fcmajo%2F8%2F2%2FE242.atom) 

8.  Schor NF (2018) The decanal divide: women in decanal roles at U.S. medical schools. Acad Med 93:237–40.
    
    [PubMed](http://www.cmajopen.ca/lookup/external-ref?access_num=http://www.n&link_type=MED&atom=%2Fcmajo%2F8%2F2%2FE242.atom) 

9.  Smith MS (2018) Equity at Canadian universities: national disaggregated, and intersectional data (Academic Women’s Association, University of Alberta, Edmonton).
    
    

10. Klein R, Julian KA, Snyder ED, et al. (2019) Gender bias in resident assessment in graduate medical education: review of the literature. J Gen Intern Med 34:712–9.
    
    [CrossRef](http://www.cmajopen.ca/lookup/external-ref?access_num=10.1007/s11606-019-04884-0&link_type=DOI) 
    
    [PubMed](http://www.cmajopen.ca/lookup/external-ref?access_num=30993611&link_type=MED&atom=%2Fcmajo%2F8%2F2%2FE242.atom) 

11. Mueller AS, Jenkins TM, Osborne M, et al. (2017) Gender differences in attending physicians’ feedback to residents: a qualitative analysis. J Grad Med Educ 9:577–85.
    
    

12. Turrentine FE, Dreisbach CN, St Ivany AR, et al. (2019) Influence of gender on surgical residency applicants’ recommendation letters. J Am Coll Surg 228:356–65.e3.
    
    

13. Arya S, Mahendira D, Pattani R (July 24, 2018) Bilateral necrotizing scleritis: a deeper look at a vision-threatening illness. J Clin Rheumatol doi:10.1097/RHU.0000000000000858, [Epub ahead of print].
    
    [CrossRef](http://www.cmajopen.ca/lookup/external-ref?access_num=10.1097/RHU.0000000000000858&link_type=DOI) 

14. Ley TJ, Hamilton BH (2008) Sociology. The gender gap in NIH grant applications. Science 322:1472–4.
    
    [Abstract/FREE Full Text](http://www.cmajopen.ca/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiQUJTVCI7czoxMToiam91cm5hbENvZGUiO3M6Mzoic2NpIjtzOjU6InJlc2lkIjtzOjEzOiIzMjIvNTkwNy8xNDcyIjtzOjQ6ImF0b20iO3M6MjA6Ii9jbWFqby84LzIvRTI0Mi5hdG9tIjt9czo4OiJmcmFnbWVudCI7czowOiIiO30=) 

15. Filardo G, da Graca B, Sass DM, et al. (2016) Trends and comparison of female first authorship in high impact medical journals: observational study (1994–2014). BMJ 352:i847.
    
    [Abstract/FREE Full Text](http://www.cmajopen.ca/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiQUJTVCI7czoxMToiam91cm5hbENvZGUiO3M6MzoiYm1qIjtzOjU6InJlc2lkIjtzOjE3OiIzNTIvbWFyMDJfMTcvaTg0NyI7czo0OiJhdG9tIjtzOjIwOiIvY21ham8vOC8yL0UyNDIuYXRvbSI7fXM6ODoiZnJhZ21lbnQiO3M6MDoiIjt9) 

16. Tamblyn R, Girard N, Qian CJ, et al. (2018) Assessment of potential bias in research grant peer review in Canada. CMAJ 190:E489–99.
    
    [Abstract/FREE Full Text](http://www.cmajopen.ca/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiQUJTVCI7czoxMToiam91cm5hbENvZGUiO3M6NDoiY21haiI7czo1OiJyZXNpZCI7czoxMToiMTkwLzE2L0U0ODkiO3M6NDoiYXRvbSI7czoyMDoiL2NtYWpvLzgvMi9FMjQyLmF0b20iO31zOjg6ImZyYWdtZW50IjtzOjA6IiI7fQ==) 

17. Steinberg JJ, Skae C, Sampson B (2018) Gender gap, disparity, and inequality in peer review. Lancet 391:2602–3.
    
    

18. Morgan HK, Purkiss JA, Porter AC, et al. (2016) Student evaluation of faculty physicians: gender differences in teaching evaluations. J Womens Health (Larchmt) 25:453–6.
    
    

19. Jagsi R, Griffith KA, Jones RD, et al. (2017) Factors associated with success of clinician-researchers receiving career development awards from the National Institutes of Health: a longitudinal cohort study. Acad Med 92:1429–39.
    
    [PubMed](http://www.cmajopen.ca/lookup/external-ref?access_num=http://www.n&link_type=MED&atom=%2Fcmajo%2F8%2F2%2FE242.atom) 

20. Rangel EL, Smink DS, Castillo-Angeles M, et al. (2018) Pregnancy and motherhood during surgical training. JAMA Surg 153:644–52.
    
    [PubMed](http://www.cmajopen.ca/lookup/external-ref?access_num=29562068&link_type=MED&atom=%2Fcmajo%2F8%2F2%2FE242.atom) 

21. Sattari M, Serwint JR, Neal D, et al. (2013) Work-place predictors of duration of breastfeeding among female physicians. J Pediatr 163:1612–7.
    
    [CrossRef](http://www.cmajopen.ca/lookup/external-ref?access_num=10.1016/j.jpeds.2013.07.026&link_type=DOI) 
    
    [PubMed](http://www.cmajopen.ca/lookup/external-ref?access_num=24011764&link_type=MED&atom=%2Fcmajo%2F8%2F2%2FE242.atom) 
    
    [Web of Science](http://www.cmajopen.ca/lookup/external-ref?access_num=000327543200019&link_type=ISI) 

22. Weissbart SJ, Stock JA, Wein AJ (2015) Program directors’ criteria for selection into urology residency. Urology 85:731–6.
    
    

23. Girzadas DV Jr., Harwood RC, Delis SN, et al. (2001) Emergency medicine standardized letter of recommendation: predictors of guaranteed match. Acad Emerg Med 8:648–53.
    
    [PubMed](http://www.cmajopen.ca/lookup/external-ref?access_num=11388941&link_type=MED&atom=%2Fcmajo%2F8%2F2%2FE242.atom) 

24. Hansen K, Rakic T, Steffens MC (2017) Competent and warm? Exp Psychol 64:27–36.
    
    

25. Jani H, Narmawala W, Ganjawale J (2017) Evaluation of competencies related to personal attributes of resident doctors by 360 degree. J Clin Diagn Res 11:JC09–11.
    
    

26. Jong M, Elliott N, Nguyen M, et al. (2019) Assessment of emergency medicine resident performance in an adult simulation using a multisource feedback approach. West J Emerg Med 20:64–70.
    
    

27. Pattani R, Marquez C, Dinyarian C, et al. (2018) The perceived organizational impact of the gender gap across a Canadian department of medicine and proposed strategies to combat it: a qualitative study. BMC Med 16:48.
    
    [CrossRef](http://www.cmajopen.ca/lookup/external-ref?access_num=10.1186/s12916-018-1032-8&link_type=DOI) 
    
    [PubMed](http://www.cmajopen.ca/lookup/external-ref?access_num=http://www.n&link_type=MED&atom=%2Fcmajo%2F8%2F2%2FE242.atom) 

28. Suson KD, Wolfe-Christensen C, Elder JS, et al. (2018) Differences in early career operative experiences among pediatric urologists. J Pediatr Urol 14:333.e1–e7.
    
    [PubMed](http://www.cmajopen.ca/lookup/external-ref?access_num=http://www.n&link_type=MED&atom=%2Fcmajo%2F8%2F2%2FE242.atom) 

29. Silver JK, Slocum CS, Bank AM, et al. (2017) Where are the women? The under-representation of women physicians among recognition award recipients from medical specialty societies. PM R 9:804–15.
    
    [CrossRef](http://www.cmajopen.ca/lookup/external-ref?access_num=10.1016/j.pmrj.2017.06.001&link_type=DOI) 
    
    [PubMed](http://www.cmajopen.ca/lookup/external-ref?access_num=28606837&link_type=MED&atom=%2Fcmajo%2F8%2F2%2FE242.atom) 

30. Huggett KN, Greenberg RB, Rao D, et al. (2012) The design and utility of institutional teaching awards: a literature review. Med Teach 34:907–19.
    
    [PubMed](http://www.cmajopen.ca/lookup/external-ref?access_num=23110357&link_type=MED&atom=%2Fcmajo%2F8%2F2%2FE242.atom) 

31. Silver JK, Bank AM, Slocum CS, et al. (2018) Women physicians underrepresented in American Academy of Neurology Recognition Awards. Neurology 91:e603–14.
    
    

32. Silver JK, Bhatnagar S, Blauwet CA, et al. (2017) Female physicians are underrepresented in Recognition Awards from the American Academy of Physical Medicine and Rehabilitation. PM R 9:976–84.
    
    [CrossRef](http://www.cmajopen.ca/lookup/external-ref?access_num=10.1016/j.pmrj.2017.02.016&link_type=DOI) 
    
    [PubMed](http://www.cmajopen.ca/lookup/external-ref?access_num=28336430&link_type=MED&atom=%2Fcmajo%2F8%2F2%2FE242.atom) 

33. Silver JK, Blauwet CA, Bhatnagar S, et al. (2018) Women physicians are underrepresented in recognition awards from the Association of Academic Physiatrists. Am J Phys Med Rehabil 97:34–40.
    
    

34. Krzyzaniak SM, Parsons M, Rocca N, et al. (2019) What emergency medicine rewards: Is there implicit gender bias in national awards? Ann Emerg Med 74:753–8.
    
    [PubMed](http://www.cmajopen.ca/lookup/external-ref?access_num=http://www.n&link_type=MED&atom=%2Fcmajo%2F8%2F2%2FE242.atom) 

35. (2019) Our provincial partners (Resident Doctors of Canada, Ottawa) Available: [https://residentdoctors.ca/about/our-provincial-partners/](https://residentdoctors.ca/about/our-provincial-partners/). accessed 2019 Oct 25.
    
    

36. CAPER/RCEP (2019) Census data tables (Canadian Post-M.D. Education Registry, Ottawa) Available: [https://caper.ca/postgraduate-medical-education/census-data-tables](https://caper.ca/postgraduate-medical-education/census-data-tables). accessed 2019 June 4.
    
    

37. (2018) Physicians by specialty, province, age and sex (2000 to present) (Canadian Medical Association, Ottawa) Available: [https://www.cma.ca/canadian-physician-data](https://www.cma.ca/canadian-physician-data). accessed 2018 June 27.
    
    

38. Simpson D, Hafler J, Brown D, et al. (2004) Documentation systems for educators seeking academic promotion in US medical schools. Acad Med 79:783–90.
    
    [CrossRef](http://www.cmajopen.ca/lookup/external-ref?access_num=10.1097/00001888-200408000-00014&link_type=DOI) 
    
    [PubMed](http://www.cmajopen.ca/lookup/external-ref?access_num=15277136&link_type=MED&atom=%2Fcmajo%2F8%2F2%2FE242.atom) 
    
    [Web of Science](http://www.cmajopen.ca/lookup/external-ref?access_num=000223002000010&link_type=ISI) 

39. About CanMEDS (Royal College of Physicians and Surgeons of Canada, Ottawa) Available: [www.royalcollege.ca/rcsite/canmeds/about-canmeds-e](http://www.royalcollege.ca/rcsite/canmeds/about-canmeds-e). accessed 2020 Mar. 16.
    
    

40. MacNell L, Driscoll A, Hunt AN (2015) What’s in a name: exposing gender bias in student ratings of teaching. Innov High Educ 40:291–303.
    
    

41. Lyons NB, Bernardi K, Huang L, et al. (2019) Gender disparity in surgery: an evaluation of surgical societies. Surg Infect (Larchmt) 20:406–10.
    
    

42. King JT Jr., Angoff NR, Forrest JN Jr., et al. (2018) Gender disparities in medical student research awards: a 13-year study from the Yale School of Medicine. Acad Med 93:911–9.
    
    

43. Carnes M, Geller S, Fine E, et al. (2005) NIH Director’s Pioneer Awards: Could the selection process be biased against women? J Womens Health (Larchmt) 14:684–91.
    
    [PubMed](http://www.cmajopen.ca/lookup/external-ref?access_num=16232100&link_type=MED&atom=%2Fcmajo%2F8%2F2%2FE242.atom) 

44. Gordon MB, Osganian SK, Emans SJ, et al. (2009) Gender differences in research grant applications for pediatric residents. Pediatrics 124:e355–61.
    
    [Abstract/FREE Full Text](http://www.cmajopen.ca/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiQUJTVCI7czoxMToiam91cm5hbENvZGUiO3M6MTA6InBlZGlhdHJpY3MiO3M6NToicmVzaWQiO3M6MTA6IjEyNC8yL2UzNTUiO3M6NDoiYXRvbSI7czoyMDoiL2NtYWpvLzgvMi9FMjQyLmF0b20iO31zOjg6ImZyYWdtZW50IjtzOjA6IiI7fQ==) 

45. Kalyani RR, Yeh HC, Clark JM, et al. (2015) Sex differences among career development awardees in the attainment of independent research funding in a department of medicine. J Womens Health (Larchmt) 24:933–9.
    
    

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