Levy B and Merchant T, Differences in Clinical Experiences Based on Gender of Third-Year Medical Students in a Required Family Medicine Preceptorship. Academic Medicine 2002;77:1241-46. Reviewed by Bob Swantz, University of Rochester
Levy B and Merchant T, Differences in Clinical Experiences Based on Gender of Third-Year Medical Students in a Required Family Medicine Preceptorship. Academic Medicine 2002;77:1241-46.
Reviewed by Bob Swantz, University of Rochester
This paper addresses the question of whether the gender of a student or preceptor affects the student's level of experience with clinical skills during a three-week long third year community-based family medicine preceptor- ship. Over a 3 year span a total of 491 students rated 57 clinical skills on a 5-point scale (reflecting increasing involvement in and increasing frequency of activity during) by recall at the completion of their preceptorship experience. The clinical skills were categorized as "female-specific" (12 skills such as breast exam, contraception counseling, vaginal delivery), "male-specific" (3 skills of circumcision, testicular exam instruction, prostate exam), and "gender-neutral" (42 skills including EKG interpretation, flexible sigmoidoscopy, smoking cessation counseling, etc.).
Based on the gender of the student, there were differences in 13 of the 57 clinical skills (23%) with men having more experience than women in 2 of the 3 male-specific tasks and women having more experience than men in 8 of the 12 female-specific skills. Male preceptors provided more experience with 6 gender-neutral procedures, but no difference with regard to the 3 male-specific skills. Conversely, preceptors who were women provided more experience with 7 of 12 female-specific skills, and with management of depression and anxiety. The analysis of gender specific skills based on student-preceptor gender dyads showed that the highest levels of experience occurred with same-gender student-preceptor-patient combinations, while the lowest levels of experience occurred with same-gender student-preceptor seeing patients of opposite gender.
The implications for students and preceptors on a pediatric rotation largely relate to adolescent care, where clinical skills begin to assume gender-specificity. This could be a significant issue, since there often is a heightened sensitivity to/by the patient if they are undergoing a gender-specific exam/counseling, particularly if it is for the first time. Also, the disparities in experiences may have more of an impact on overall educational experiences, since students may not receive opportunities to learn many of these pediatric-specific skills in other rotations. The authors appropriately acknowledge the limitations of this study, including analysis of experiences in a single specialty, data collection by recall, and disproportionately fewer women preceptors. As well, the study was not designed to look at potential causal relationships of student preferences, preceptor practice characteristics, or patient preferences with any differences in experiences. These factors might in fact be more important than the gender issues. Although the results of this study are not unexpected, they are useful to increase student and teacher awareness of potential differences in learning experiences.
(Outside of basic instructions regarding chaperones and privacy during the physical examination of near adolescent and adolescent patients - gender issues are rarely explicitly discussed in our clerkship - If you were precepting a male and female student - and an adolescent male was to be seen, would you be more likely to assign the male student to see the patient? Would you be more likely to have the female student see the patient if the patient were female? Try to answer as honestly as you can. Steve Miller).