Journal of Clinical Oncology, Vol 15, 2722-2727, Copyright © 1997 by American Society of Clinical Oncology
Are there sex biases in standardized tests of radiation oncology knowledge?
EC Halperin and GJ Broadwater
Department of Radiation Oncology, Duke University Medical Center, Durham, NC 27710, USA. halperin@radonc.duke.edu
PURPOSE/OBJECTIVE: Recent studies have identified biases directed against
women in standardized tests. We tested for the existence of such biases in
the American College of Radiology (ACR) In-Training Examination in
Radiation Oncology and the American Board of Radiology (ABR) Written
Radiation Oncology Board Examination. MATERIALS AND METHODS: Our request to
the ABR to permit us to study performance on their examinations, as a
function of sex, was refused. We obtained scores, through the cooperation
of six academic radiation oncology departments, for residents-in-training
taking the in-service examination and candidates taking the written board
examination for the first time. Test results for 1984 to 1995 were blinded
as to name, but not sex or institution of training. For the in-service
examination, scores are reported as percentiles normalized to the year of
training. The effect of multiple scores for the same resident was assessed
using a repeated-measures analysis of variance. Residents were nested
within each sex/institution combination and crossed with training year and
calendar year. The effects of three factors (sex, institution, and year the
examination was taken) on the results of the biology, physics, and clinical
sections were evaluated with an analysis of variance. The interactions of
sex with institution and year were included to determine the scope of the
sex effect. For the board examination, scores are reported as percentiles,
as well as an overall pass/ fail outcome. An analyses of variance was
performed similar to that used for the in-service examination. In addition,
Fisher's exact test and logistic regression were used to analyze overall
outcome (pass/fail). RESULTS: We obtained data for 79 residents (48 men and
31 women, 1.54:1) who took the in-service examinations 165 times. Sixty-two
residents (41 men and 21 women, 1.95:1) had an initial sitting for the ABR
written examination. On the in-service examination, for the biology,
physics, and clinical subsections, calendar year, training year, and sex
did not have a significant effect on examinees scores. Institution of
training had a significant effect (P < .02) on the scores in biology and
physics. The total in-service examination scores were not significantly
influenced by calendar year, training year, or sex. Institution of training
has a strong influence on overall score (P = .03) and the interaction of
sex with training year is near significance level (P = .06). The power for
our statistical tests ranged from 0.88 to 0.99. On the board examination,
sex, institution of training, year the examination was taken, and
interaction of sex with year or sex with institution of training did not
have a significant effect on test scores. Pass rates were 90% for men
versus 81% for women (P = .43). CONCLUSION: Sex did not significantly
influence the results of the in-service examination or the written board
examination. Institution of training is the strongest influence on the
results of the in-service examination.
