Why do women continue to face barriers to success in professions, especially male-dominated ones, despite often outperforming men in similar subjects during schooling? With this study, we draw on role expectations theory to understand how inequality in assessment emerges as individuals transition from student to professional roles. To do this, we leverage the case of medical residency so that we can examine how changes in role expectations shape assessment while holding occupation and organization constant. By analyzing a dataset of 2,765 performance evaluations from a three-year emergency medicine training program, we empirically demonstrate that women and men are reviewed as equally capable at the beginning of residency, when the student role dominates; however, in year three, when the colleague role dominates, men are perceived as outperforming women. Furthermore, when we hold resident performance somewhat constant by comparing feedback to medical errors of similar severity, we find that in the third year of residency, but not the first, women receive more harsh criticism and less supportive feedback than men. Ultimately, this study suggests that role expectations, and the implicit biases they can trigger, matter significantly to the production of gender inequality, even when holding organization, occupation, and resident performance constant.

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Gendered differences in workload distribution, in particular who spends time on low-promotability workplace tasks—tasks that are essential for organizations yet do not typically lead to promotions—contribute to persistent gender inequalities in workplaces. We examined how gender is implicated in the content, quality, and consequences of one low-promotability workplace task: assessment. By analyzing real-world behavioral data that include 33,456 in-the-moment numerical and textual evaluations of 359 resident physicians (subordinates) by 285 attending physicians (superordinates) in eight U.S. hospitals, and by combining qualitative methods and machine learning, we found that, compared to men, women attendings wrote more words in their comments to residents, used more job-related terms, and were more likely to provide helpful feedback, particularly when residents were struggling. Additionally, we found women residents were less likely to receive substantive evaluations, regardless of attending gender. Our findings suggest that workplace assessment is gendered in three ways: women (superordinates) spend more time on this low-promotability task, they are more cognitively engaged with assessment, and women (subordinates) are less likely to fully benefit from quality assessment. We conclude that workplaces would benefit from addressing pervasive inequalities hidden within workplace assessment, equalizing not only who provides this assessment work, but who does it well and equitably.

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How do clinicians manage the negative emotions that emerge when hospital patients are dissatisfied with their pain treatment? Drawing on a 21-month hospital ethnography, I show that clinicians view opioids as tools that can allow them to avoid engaging in emotional labor with dissatisfied pain patients. I detail two different strategies that clinicians pursued. Through permissive prescription, clinicians used intravenous (IV) opioids liberally to placate unhappy pain patients, temporarily minimizing patients’ emotional needs. Through restrictive prescription, clinicians advocated for the more conservative use of IV opioids in the hopes that dissatisfied patients would leave the hospital, reducing their overall emotional workload. Divergent strategies for using opioids to avoid emotional labor led to hierarchical interprofessional conflict, which was itself a source of negative emotions that needed to be managed. Based on these findings, I argue that the desire to avoid emotional labor can shape patient care and workplace relationships.