Richard M. Frankel

Despite performing equally to their male peers in the classroom and the clinic, female medical students consistently report decreased self-confidence and increased anxiety, particularly over issues related to competency. That's the finding of a recent study published in Patient Education and Counseling, which also found that female medical students appear less confident to patients.

For the study, 141 third year medical students at the Indiana University School of Medicine were videotaped during their objective structured clinical examination (OSCE), in which they interact with individuals simulating patients. The students were given a battery of tests, and trained observers rated how confident the student appeared, coding a variety of nonverbal behaviors at the beginning, middle, and end of the interaction.

The female medical students appeared significantly less confident than male medical students to independent observers, especially at the beginning of the interaction.

"Female medical students self-reported less self-confidence than the male medical students and were also observed by trained raters to be less confident," says senior author Richard M. Frankel, professor of medicine at the IU School of Medicine and a Regenstrief Institute research scientist.

"Despite objective test performance that is equal to or greater than their male classmates," he continues, "there was something about the way in which the female medical students were observed and experienced their communication with patients that made them less confident."

These observations regarding female medical students help to answer an important question about whether women students are simply more willing than men to admit that they are feeling anxious, stressed, or unconfident.

Women now comprise more than half of the applicants to medical schools in the United States but medical educators may not be aware of gender differences in their student population, the study authors note.

"Our finding of decreased confidence among female medical students is important because it makes it very clear that in the training of future physicians, the issue of confidence needs to be addressed," says Frankel, who studies both medical education and the doctor-patient relationship. "Accomplishing this may be as straightforward as increasing faculty sensitivity and changing some simple learned behavior, but we will need more research to fully understand this phenomenon and its implications for medical education."

A literature survey by the study authors, which accompanied their observational report and analysis, shows that while there is no consistent gender difference in academic performance, female medical students tend to underestimate their abilities while males tend to overestimate theirs.

The literature survey also found that by the end of medical school, male students had achieved a greater level of identification with the role of doctor than female students with the same medical school experience. Only female students reported thinking about confidence in their knowledge when asked to assess their identification with the role of doctor.

In a future study, Frankel and the rest of the research team hopes to observe how a doctor's confidence in her or his abilities changes over time from medical school through residency training to medical practice.

Authors of the study included Danielle C. Blanch and Judith A. Hall of Northeastern University, and Debra L. Roter of Johns Hopkins Bloomberg School of Public Health. The study was funded by the Fetzer Institute of Kalamazoo, Michigan.