Patient Evaluation of White vs Non-White Surgical Senior and Intern Residents

Purpose : Patient feedback may serve as a valuable source of information for surgical resident assessment. However, there is also recognition that systematic bias in any new forms of surgical resident evaluation could further disadvantage historically marginalized groups. This exploratory study investigated whether patient ratings of surgical resident care differ by resident race or underrepresented in medicine (URiM) status. Methods : Surgical inpatients who underwent elective gastrointestinal and oncologic surgery evaluated the quality of surgical resident care using a modified Consumer Assessment of Healthcare Providers and Systems Surgical Care Survey (S-CAHPS). The top-box method, which quantifies the frequency of the highest possible rating for each question, was used to analyze patient satisfaction with surgical resident care in a manner consistent with S-CAHPS reporting guidelines. Patient evaluations of senior and intern residents were stratified by resident race and underrepresented in medicine (URiM) status and compared both across and within gender. Results : A total of 324 patients completed 267 evaluations for senior residents and 256 evaluations for intern residents. There were no significant demographic differences between patients evaluating White vs non-White residents at either the senior or intern level (age, gender, or education level). Patient recognition rate of White vs non-White residents did not differ at either the senior (White 85.1% vs non-White 84.8%, p-value=1.0) or intern level (White 80.1% vs non-White 88.8%, p-value=0.085), even after accounting for gender. Top-box S-CAHPS scores across all 8 domains did not significantly differ between evaluations for White and non-White residents for both senior (p>0.10) and intern (p>0.36) residents, including when further stratified by gender. Similar results were observed when examining resident evaluation by URiM status, where patient recognition rate did not differ at either the senior (non-URiM 84.5% vs URiM 90.3%, p-value=0.545) or intern level (non-URiM 83.0% vs URiM 80.8%, p-value=0.982), even after accounting for gender. While there were no differences between the proportion of URiM compared to non-URiM senior evaluations that received top-box scores in 7 individual S-CAHPS items, a difference was observed in the item related to pain treatment. Specifically, 91.5% (214/229) of evaluations for non-URiM seniors had the top-box score whereas 71.4% (20/28) of evaluations for URiM seniors had the top-box score (p=0.004). However, patient-reported pain scores did not significantly differ between these groups, and this difference was not observed after further stratification by gender. Top-box S-CAHPS scores across all 8 domains did not significantly differ between non-URiM and URiM resident evaluations for intern (p>0.19) residents. Conclusions : Patient recognition rate and quality of care evaluations were overall similar regardless of surgical resident race or URiM status, including when further stratified by gender. These findings support the potential for patient feedback to serve as a valuable component of resident assessment. Further research is needed to explore how best to utilize patient evaluations to support all trainees as they prepare for independent practice.