Standardized patient gender influences diagnostic accuracy in undergraduate medical students' cardiac OSCE interviews

Objectives: This study aimed to assess the influence of standardized patient and student gender on the undergraduate medical students' performance during the interview station of Objective Structured Clinical Examinations (OSCE). Methods: This study was conducted among fourth-year medical students during an OSCE at the University of Toulouse, France. Standardized patients, examiners, and students were blinded to the study design. Four gender-neutral clinical cases were developed, involving cardiac diagnoses: case 1: acute coronary syndrome; case 2: musculoskeletal chest pain; case 3: cardiac arrhythmias with acute coronary syndrome; case 4: vasovagal syncope. The primary outcome was the diagnostic hypothesis proposed by the student at the end of the standardized patient interview. Results: A total of 357 fourth-year students were assessed. The mean age of the students was 22 years (±2.6) and 225 (63.0%) were female. Ten standardized patients were involved, (7 female, median age: 51 [IQR 44-60]; 3 male, median age: 55 [IQR 50-59]). The rate of correct diagnostic hypotheses was significantly higher with male standardized patients (64.9% [95% CI, 55.0%-73.7%]) than with female standardized patients (45.6% [95% CI, 39.5%-51.8%]; p = 0.002). Female students were also less likely to propose correct diagnoses with female standardized patients (40% vs. 66.2%, p = 0.003) compared to male students (50% vs. 62%, p = 0.25). Conclusion: Our study supports that diagnostic hypothesis proposed by undergraduate medical students at the interview station during OSCEs is influenced by standardized patient gender, with a higher likelihood of incorrect diagnoses when the standardized patient is female, despite gender-neutral clinical cases. Diagnostic accuracy may also be influenced by student gender. These findings suggest that gender bias exists from the early stages of medical training.