Gender bias in the clinical reasoning steps of medical students: a critical examination

Despite growing awareness of the importance of integrating gender knowledge into medical education, gender stereotypes persist and may influence patient assessment and management. This study investigates gender inequalities in clinical reasoning among medical students to identify areas for improvement in medical education.

The study was conducted at the University of Lausanne in Spring 2021, using the Objective Structured Clinical Examination (OSCE) to assess fifth-year medical students. Students were evenly assigned to interactions with either a male or female standardised patient (SP) presenting with unintentional weight loss. Evaluation covered history taking, physical examination, and clinical management. A total of 105 students (57.1% female, 42.9% male) were assessed.

Results indicate potential gender bias at various stages of clinical reasoning, with patterns depending on the gender of both the SP and the student. During history-taking, female students were less likely to ask female SPs about alcohol consumption than male SPs (56.3% vs. 78.6%, p = 0.07). Regarding occupational history, a compelling trend was also observed among male students, who asked female SPs less often (30.4% vs. 59.1%, p = 0.05), whereas female students showed more consistent rates. Additional compelling trends emerged during physical examinations: male students performed cardiac auscultation less often on female SPs (56.5% vs. 86.4%, p = 0.02). Although diagnostic hypotheses and differential diagnoses were similar, female SPs were more often prescribed laboratory tests (63.6% vs. 26.0%, p < 0.001).

Gender bias permeates multiple stages of clinical reasoning among medical students, leading to under-recognition of key health risk factors, differences in examination thoroughness, and increased prescription of laboratory tests in female patients. Addressing gender bias through sustained integration of gender into core medical education is essential for diagnostic accuracy and high-quality patient care. Specifically, systematic inquiry into occupational and alcohol histories in female patients, improved cardiovascular auscultation, and enhanced communication with male patients are needed.