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 their competency. A new study published in the September 2008 issue of Patient Education and Counseling found that female medical students also appeared less confident to patients.

“We observed third-year medical students interacting with individuals simulating patients and gave the students a battery of tests measuring non-verbal sensitivity. Female medical students self reported less self confidence than the male medical students and were also observed by trained raters to be less confident. Despite objective test performance that is equal to or greater than their male classmates 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” said the study’s senior author Richard M. Frankel, Ph.D., professor of medicine at the Indiana University School of Medicine and a Regenstrief Institute research scientist.

Observing the female medical students and finding that they actually appeared less confident in their interaction with patients than male counterparts answered the important question of whether women were simply more willing than men to admit that they are feeling anxious, stressed or that they lack confidence in their abilities.

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 somewhere in the training of future physicians, the issue of confidence needs to be addressed. 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,” said Dr. Frankel, a medical sociologist who studies both medical education and the doctor-patient relationship.

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. Interestingly, 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 the research team hopes to observe how doctors’confidence in their abilities change over time from medical school through residency training to medical practice.

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

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