Exploring Gender Bias in Cardiovascular Medical Education Through Clinical Simulation

Abstract While it has been proven that women suffer disproportionately from cardiovascular disease-related deaths, the origins of this differential gender-based outcome remain unidentified. One possible cause is gender bias and associated discrepancies in how physicians assess the need for interventions in male versus female patients. This study aimed to identify early gender biases in cardiovascular care by assessing medical students’ management of a ruptured abdominal aortic aneurysm case presentation in male and female simulated patients. Clerkship students (n = 187) were randomly assigned to either a male or female patient with identical case presentations, simulated using high-fidelity mannequins. Minutes passed until point-of-care ultrasound (POCUS) usage served as a surrogate for diagnostic reasoning, while minutes passed until surgery consultation call served as a surrogate for successful intervention. Two-way ANCOVA of time to surgery call and POCUS use showed no significant interaction between student and patient gender (p=0.819). Likewise, neither patient gender (p=0.210) nor student gender (p=0.653) had an impact on ultimate correct diagnosis. However, there appeared to be an association (p=0.010) between patient and student gender in the factorial ANOVA of POCUS use, F(1,183) = 6.862 effect size 0.36. While slight in-group bias was identified within the context of imaging, students predominantly called for the correct intervention regardless of their own or their patient’s gender. It is thus unlikely that medical students develop gender biases serious enough to impact clinical outcomes during clerkship-instead, these heuristics may be formed later in training.