Purpose It has long been known that the gender of the physician and of the patient can impact variables of medical communication. In this experiment, we study the effect of both student and standardized patient (SP) gender as it relates to the sexual history taking and HIV risk reduction counseling.
Methods At the University of Kentucky College of Medicine, the third-year class must adequately complete a 13-station standardized patient clinical examination to matriculate into the fourth year. Each station is graded by a checklist of salient items completed by the SP. One of the stations, the HIV risk reduction counseling case, was developed to be portrayed by both a male and female SP and contained gender-specific items on the checklist. There were eighty total items on the female checklist and sixty-nine total on the male checklist. The male checklist contained eleven and the female seventeen sexual history items and both contained ten HIV counseling items. One-half of all the students interviewed a man at risk for HIV and the other students encountered a woman. Every student had an equal chance to encounter either gender. A gender-neutral anxiety case was used as the control. Multiple regression approaches solving for measures of prior clinical performance and using the general linear model were used to analyze the data with SAS.
Results Ninety-seven students completed the CPX. Forty-nine encountered a female SP and forty-eight a male SP. There were twenty-two women in both groups. The performance of the female students was superior to that of the men in regards to both the elements of the sexual history taking and the HIV risk reduction counseling (62.8 ± 13.7 vs. 56.4 ± 15.2, p < .001 and 69.4 ± 6.9 vs. 67.4 ± 9.2, p = .009, respectively). Furthermore, when a woman encountered a female SP, the mean checklist score for sexual history items was 63.6 ± 15.9 and for HIV counseling was 72.2 ± 6.5 compared to male students interviewing men, 51 ± 13.1, and 63.0 ± 7.5, respectively, p < .001 for both groups.
Conclusions Female medical students score better than their male counterparts on sensitive elements of a standardized patient encounter, sexual history taking, and HIV risk reduction counseling. In fact, even when there are more items to ask, i.e., in an encounter with a female SP, the female students continue to excel. Limitations to our study include single institution and study of only one SP case. However, despite these limitations, our findings suggest both areas of future focus for clinical medical education and possible gender influences in actual patient-physician encounters.